Anyone with BCBS of TN ?

cavalier · #1 (**permalink**) 06-06-2009, 10:30 PM

Anyone had any luck in getting part of all of their ADR surgery paid for by BCBS of TN I have a PPO. If denied of approved please post. Also what year it was approved or denied. Thank you Jill

Dulishun · #2 (**permalink**) 06-07-2009, 12:39 AM

Jill,

It appears from their website that they do not currently approve it, but there is also a Policy Statement Draft on the site that can be found by typing "Artificial Intervertebral Disc" as a search term on Health Insurance in Tennessee, BlueCross BlueShield of Tennessee . I downloaded the attachment, which is in pdf. and posted it here. It essentially appears to be a forthcoming reversal of their policy in reference to Cervical ADR only, but once again is only a draft. It was written on May 28th, 2009 according to the properties. Does this help or does it help confuse things???

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L5S1 Herniation and Annular tear
Over 10 epidurals,
DDD, 2 discograms (positive),
Countless attempts at conservative therapy.
Surgery date 5-26-09

cavalier · #3 (**permalink**) 06-07-2009, 01:00 AM

I had gone to their website & printed off this VERY SAME Draft - it is looking like they are GETTING ready to reverse their policy for ONLY Cervical - it states that Lumbar & Thoracic they still feel is investigational - which is interesting even though the Lumbar ADR's have been in the field longer than the Cervical ADR
's have. My guess is that they feel due to the less load on the cervical it will have even less stress than the Lumbar ADR's. I just wonder how long this will be in the almost stage ! So that is why I wondered if any Cervie ADR's had been approved. That is what I am needing so would be nice to have for once a surgery paid for - my L4L5 adr is now coming on 5 yr's old by Dr B. which we had to pay for even though the insur. would have paid up to 150 K for a 2 level fusion i was already herniated at L3L4. It was well worth paying for but at least some help this time would be grand! My Best - Jill

Dulishun · #4 (**permalink**) 06-07-2009, 01:03 AM

You can actually go to this web page: Draft Medical Policies and use the reference number for this draft to e-mail comments to them regarding it. Good luck.

-----------------------------------------------------------------------------
L5S1 Herniation and Annular tear
Over 10 epidurals,
DDD, 2 discograms (positive),
Countless attempts at conservative therapy.
Surgery date 5-26-09

Dulishun · #5 (**permalink**) 06-07-2009, 01:08 AM

It could be worse, I live in South Carolina and have United. At least with BCBS it seems that there is some hope and my Neurosurgeons office told me that BCBS of SC has approved a handful this year at their office, but it may just be cervical I am not sure. When I called Synthes to ask about helping me with United Healthcare, the guy basically said that I had no chance in so many words. At the end of the conversation I asked him of I was SOL and he said "um...yeah".

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L5S1 Herniation and Annular tear
Over 10 epidurals,
DDD, 2 discograms (positive),
Countless attempts at conservative therapy.
Prodisc-L, Surgery date 5-26-09

cavalier · #6 (**permalink**) 06-07-2009, 04:59 AM

Well I was told the same thing when I called to Prodisc last week & talked to the USA rep - they said BCBS of TN has never approved to date a ADR. They said other states with BCBS has but not so far. However, I still say let it be submitted & try to fight it if they deny - after all what do you have to loose ? That is my opinion, other than time.

Jill