has anyone won an appeal for lumbar ADR when considered "investigational"?
 

Hello. I'm a newbie to this forum. To make a long story short, I have a dessicated L5 - S1 disk. My surgeon recommends ADR which I prefer over fusion; however, my insurance company BCBS of Louisiana has a policy against ADR stating that it is investigational. I decided to appeal. After a few weeks of research, I am a bit overwhelmed and could use some help. Has anyone ever won an appeal for lumbar artificial disk replacement when insurance labels it as "investigational"? If you have, would you be willing to share your appeal or pointers with me? I feel lost in the process of reading loads of articles; letters; opinions; studies; policies; court cases, and on and on. I would appreciate any assistance someone can offer. Thank you.

LA Gal i am sorry i have no experience with ADR. I hope someone else on here does and comes forward to help you. I was never a candidate for it do to bad bone density.
However, most of all my 9 spine surgeries have first been denied by Aetna , the way they get turned around is when my surgeon does a peer to peer phone call with their doctor. I don't know if that has been tried in your case.
Just want to wish you good luck. I have also battled Aetna for other issues and eventually won. Just takes a lot out of you sometimes
Judy

LA Gal, welcome to the forum.

Contact me off the forum and I'll send you some successful appeals. Unfortunately, BCBS is the worst of the worst at paying for ADR.

Mark

(You can reach me via the global patient network website linked below.)