Blue Cross Denied Fusion - Help Needed

[JulieAnnaAK]

I have double health care coverage. Blue Cross is my secondary- they approved both my lumbar and cervical fusions on the first attempt. Incidently my Primary Western Grocers denied both of my fusions.

On the PLIF they also said it was reviewed by their Neuro Surgeon and was not medically necessary. When I asked for the corasponence I discovered that their Neuro Surgeon was not a NS at all. He was a IME! My NS called him and did the peer to peer review and my appeal was approved. Partly I am sure because I called them out on the IME pretending to be a NS.

On the ACDF again Western Grocers took the word of a hired neurologist who performed my nerve conduct study for my NS He was from one of those large spine clinics & said I didn't need surgery just some PT and traction (at his clinic of course). I had to go through 12 more weeks of PT (not his clinic). Traction made me pass out (I had some form of vertebular artery blockage from an island style bone spur than moved with pressure). PT was 2x per week getting a mt. I basically spent 3 months on the couch waiting/miserable.

[dshobbies]

Waiting/miserable - same story, different details. Why ins cos put us all through this. They're disgusting!