Denied By Blue Cross as Well!
I am a 35 year old female with a 2 1/2 year old daughter. I currently pay Anthem Blue Cross $666 per month for my medical insurance premium for me alone. Anthem Blue Cross denying me a procedure 6 Orthopaedic Surgeons say I need. Anthem\'s employeed physician says it\'s \"Not Medically Necessary\".
Over the past 3 1/2 years I\'ve had really bad lower back pain and sciatica running down my entire buttocks and left leg to foot. I\'ve tried all conservative methods the doctors gave as a course of treatment, anti-inflammatory medications, pain medications, physical therapy, acupuncture, injections, chiro, light exercise, massage, etc. All of which either provided very little to no help. The pain has moved into my right leg recently so doctors ordered 2nd MRI which showed completely degenerated disc and bulge and doctors say spinal fusion at L5 S1. 2 days before the surgery...Anthem Blue Cross paid physician \"Dr. Marappa Gopinath\" denies the authorization stating not medically necessary based on a Milliman Care Guide. Also my Surgeon put in multiple requests for a Peer to Peer (what physicians will often do so they can help the Anthem Physician understand your injury or problem). Their \"Dr.\" never returned my doctors call and did not honor the peer to peer. After sending over records from other physicians which supported the surgery, Anthem \"Dr.\" still denied the authorization. I\'m only 35...how can Anthem be allowed to force me to be in pain for the rest of my life or go bankrupt trying to finance this procedure on my own. How do I take care of my 2 1/2 year old daughter with this back pain and sleep deprived from the pain. Is this legal? Is this humane? Is this what average income Americans should expect moving forward in terms of quality of life and Healthcare?
Has anybody talked to an Attorney?
Please Help
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