BCBS of Texas

symara · #1 (**permalink**) 05-07-2009, 03:13 PM

I wonder why they are approving for Cervical, but still concider Lumbar experimental?????

jchebert1979 · #2 (**permalink**) 05-07-2009, 03:41 PM

I have no idea, I thought the Lumbar discs have been around longer. At any rate, I am not giving them a chance to deny my case. I have written a full denial appeal as per "The insurance warrior's book" and worded it as a "pre-approval request". It will be sent in with my doctors pre-approval request tomorrow and I will also send a copy certified mail.

symara · #3 (**permalink**) 05-07-2009, 04:12 PM

are you requesting cervical or lumbar? Keep us updated.

jchebert1979 · #4 (**permalink**) 05-07-2009, 06:23 PM

Cervical. I will def. keep everyone updated.

symara · #5 (**permalink**) 05-07-2009, 06:37 PM

I work for an insurance company and just spoke to someone, there is a possibility they may not even look at the documentation and just automatically deny it the first time. We don't know for sure, so don't take our word for it, we don't work in that area, but who knows. I just hate to think that you would do all that work and someone doesn't even look at it.

jchebert1979 · #6 (**permalink**) 05-07-2009, 07:59 PM

Well the work is done and I would have had to do it anyway if they were to deny it. I realise that it could be denied off the bat which is why I put everything together in the first place. I also called my benefits department head and she said that they would help in any way possible if it were denied. I have no doubt that I will win this battle, I just need to get it over with, I am in so much pain.

jchebert1979 · #7 (**permalink**) 05-15-2009, 06:54 PM

BCBS TX approved my prodisc ADR today. They recieved all of my paperwork on 4/11/09 and approved it on 4/15/09. I hope and pray that this disc is the cause of my problems.

Yeah that should have been 5/11/09 and 5/15/09, sorry.