[kimmers]

Allan,

You have to be real careful on how you deal with Blue Cross/Anthem. They can collect on a bill after they already paid it, three years after the fact.
See cbsnews.com/stories on July 4, 2008, our esteemed Dept of Managed Health Care, the supposed over seer of HMOs in California, did not collect on the 1 million dollar fine against Blue Cross/Anthem.
That is one of the appeal processes for Blue Cross. They overturn something like only 20 percent of the appeals sent to them.
We don't have a chance in hell. Another fact, if you have a company policy instead of individual an attorney won't touch you (that is on a contingency basis).
If you have an Erisa policy, fat chance too (only,for a large fee (":30-45K") and at least 18 months to get a hearing, I was told).
People told me, why cannot you pay for the discs and they pay for the surgery since the approach for ADR and fusion are the same? Blue Cross won't consider it.
Other insurances, maybe.
I have heard of too many people getting fusion instead of a desired ADR, because of Blue Cross/Blue Shield/Anthem.
Several in my doc's office, because I was told, "they were just worn out from the pain".
You have to fight them at the ground level. One of the things I was told, if my husband had been part of a large group policy (more than 50 employees), i might have gotten some help.
With my policy, I think you can go to arbitration, which I haven't done. The language is very confusing.

You have to know too that my surgery was preauthorized. That does not mean anything to Blue Cross/Anthem.

I have a whole laundry list of what Anthem/Blue Cross, etc... is doing to rake in more money. They stopped paying for any surgeries in which the surgeon made a mistake, they stopped accepting transplant patients at UCLA.
UCLA is one of the best known heart transplant centers in Calif and the US. They are also a top liver transplant center, etc. Blue Cross will not take patients from there.
They signed up people for a policy supposedly for young people without health problems. They even say they will take care of the bumps and bruises, but not the major problems.

The easiest way to get ADR is get another insurance company involved. Aetna and Kaiser are two.
I have been told by my sources that the health editor at the LA Times just gets a massive amount of letters regarding insurance denial and rescision (sp?).

When I went up to San Francisco in June to protest the health insurance companies, I met a lady who because she had the misfortune to get cancer, stage 4, Blue Cross rescinded her policy.
If they can do that to cancer patients, what do you think they will do to us?

I have seen evidence if you are younger, under 30??, they might be more preferential to your plight.

The problem is Allan, is that they are so big, they get away with everything.

Feel free to PM me. I believe there are ways to beat them and I for one, don't think I will ever give up. I do believe they will go out of business. Look at Enron, and others.

You just have to really think out your strategy. Don't settle for a surgery you do not want.

Kimmers