overcoming BCBS denial of claim based on "experimental" nature of lumbar ADR

[leshatch]

BCBS of Texas has denied my claim for reimbursement for a single level lumbar (L5-S1) artificial disc (M6 by Spinal Kinetics) implanted October 2010 by Dr. Ritter-Lang. I see from review of this site other BCBS entities have honored such claims, but BCBS Texas has denied based on "experimental/investigational". Anyone have any suggestions to defeat this position? Thanks, Les.

[Justin]

BCBS of Texas has denied my claim for reimbursement for a single level lumbar (L5-S1) artificial disc (M6 by Spinal Kinetics) implanted October 2010 by Dr. Ritter-Lang. I see from review of this site other BCBS entities have honored such claims, but BCBS Texas has denied based on "experimental/investigational". Anyone have any suggestions to defeat this position? Thanks, Les.

Hi Les,

I'm sorry that your claim was denied. The difficult part with insurers is that the language in their policies is always changing and evolving. We did have a Spine Patient with BCBS Texas have their cervical artificial disc replacement (ADR) surgery approved a few years ago. However, I believe they have changed their position on ADR.

One option might be to contact The Insurance Warrior. Note: I only know Laurie from stories of her helping others (I have no financial relationship with her and only recommend her services based on other people's positive experiences with her).

Good luck!

[leshatch]

Thank you Justin. I have downloaded Laurie's book and will review it before my hearing.

Thanks for all your efforts in maintaining this site. It is comforting to know others are experiencing the same issues.