[manderson33]

I have just received word Anthem BCBS has denied my surgery scheduled for Nov. 1st. I was scheduled for a lumbar fusion L4, L5;L5, S1, because "I have no slippage (spondylolisthesis) or spinal instability." and "There is no record of severe narrowing where the nerves exit the spine." They do acknowledge a herniated disc and that I have back pain. I have been diagnosed with severe DDD and had a laminectomy for the same levels in '06, but re-herniated 5 months later. My surgeon at the time recommended another surgery and possible fusion, but I was not convinced surgery was the answer and wanted to try anything and everything to avoid it. Since then I have been living in pain, having to take pain meds, exhausted other treatments including chiropractic, epidurals, cortizone shots, etc. Finally getting to a point where I couldn't take it anymore, I sought the opinion of a surgeon recommended by my pain management doctor. This surgeon, who is considered conservative, has recommended lumbar fusion of both levels after receiving the results of my recent discogram and thinks the results could be quite favorable, giving me hope of living a normal life free of pain. Having heard BCBS has denied my only hope of getting better is devastating to say the least. My provider has already started the appeals process and has requested a peer to peer review. It was suggested to me that I withhold my appeal until a determination is made on the provider's appeal. Any help or suggestions are greatly appreciated. I have read some of the other insurance posts and have found comfort in knowing I am not alone, but I am wondering if any of your determinations were reversed and if so, what additional info. helped? I'd also like to know what kind of time frame your appeal process took? Thank you!