Blue Cross Denied Fusion - Help Needed

[colomom]

My teen daughter ruptured L4-5 and L5-S1 last year, and after months of PT and 3 unsuccessful rounds of spinal injections, she received a two-level discectomy, which was paid for by CIGNA. Ten months later, she started having the radiating leg pain again, and the MRI indicated a reherniation of both levels. She was unable to sit in school for longer than 10 minutes (she missed her first semester of her sophomore year last year in bed because of the same pain), and we were scheduled for surgery including the fusion of the L4-5 because the expectation is that repeating the prior procedure would net the same result. The goal was to stabilize the spine before further injury occurred and prevent a third herniation, but we were denied coverage for not attempting other non-surgical treatment, as well as not meeting the instability requirement. After almost a month of waiting (and denials), we ended up proceeding with the recommended procedure and self-paid. We could not afford for our daughter to miss another semester of school waiting for an approval that may never come. I am currently appealing, but not hopeful. It's horrific to think that we have to wait until so much irreversible damage is done before care will be provided, when we could proactively maintain the health of the spine before then and possibly prevent further surgeries and unnecessary (and costly) non-surgical treatments. My daughter is only 16, and is currently living the life of a normal, happy teenager after surgery 7 weeks ago.