Denial for Fusion L5-S1
I hurt my back 3 yrs ago and have bulging and ruptured discs.I have tried everything to avoid fusion, to no avail...nothing has helped. I saw one chiro 3x week for 1 1/2 yrs. Another chiro for diff type of treatment. A 3rd chiro for 2 months of decompression treatments. I've had 3 epidurals, RF ablation, months of Physical therapy, tried yoga and pilates. I've seen 4 Neurosurgeons in which every one of them said I need Fusion. I finally agreed and was scheduled, denied by insurance( Anthem Blue Cross), Dr attempted for over a month to do a peer to peer. Drs office said they felt they were being ignored, of course they were! When it finally did happen, they still denied surgery but said I had to go through PT first before another request. Did that, didn't help. Surgery was scheduled again,denied, did peer to peer again, denied.Did appeal, denied again.
Said same thing they tell everyone, no spinal instability. And basically that soft tissue(discs) doesn't matter.I have one appeal left. Luckily, my cousin is a lawyer and offered to help me with my final appeal. Has anyone ever actually been able to get their insurance to say yes??
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