Thread: BCBS World
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Old 08-11-2014, 04:06 AM
henry4956's Avatar
henry4956 henry4956 is offline
Join Date: Jan 2014
Location: Connecticut, USA
Posts: 48
Default Not looking good

I really had my hopes up when a BCBS WW rep called me about a month ago. He needed for me to have one document that was not legible resubmitted. This made me think, they are working on it - so that's good.

2 weeks ago I contacted BCBS RI and referred to my case # and was told all that was missing was a pre-auth or letter of medical necessity. Even if it was after the fact it would be OK. I created a draft and Dr Zeegers filled in the rest. I submitted it and about a week or so later they tell me it has been denied. I was told it would only be paid for if the surgery was an emergency and not planned in advance.

My wife just so happens to work for the man at RI Hospital who is the head guy for all things BCBS related. Her co-workers have told her he has the authority to make a call (pull a few strings) and I would get reimbursement.

At this point it seems that is my only chance. So far we have been trying to do this thing by going thru all the proper channels and it has gotten us nowhere.

How are you doing Vicki?
2001 bad fall on ice playing hockey
Apr 2001 lami/discectomy L4/L5 (large rupture)
Aug 2001 lami/discectomy L5/S1
Coccyx dislocated / same fall (Cannot sit)
Aug 2011 pull-start generator - unrelenting low back pain - can only stand for 30 min
Nov 2011 -rhizotomy - makes things worse
22 hours/day in bed
June 2012 - present receiving facet injections every 4 months, only last one helped somewhat
L3-L5 ActivL Surgery w/Dr Zeegers April 16th
Doing great!!!!!
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