I was scheduled for adr @ l5-s1 on 4/8 but was just denied 3/29 "investigational/experimental" was the reason (excuse) given. The insurance co is highmark bc/bs of western PA. They are a 3rd party administrator for the company I work for that is self insured. My employer told me they can't tell bc/bs what to do...I wonder?? anyway I am appealing. I live in MD but my employer is based in pa with branches in maryland. My doctor was told by bc/bs during the peer to peer review "we are not paying for ANY disc replacments". I feel like they already have their minds made up to deny any appeals and that this is just a formality for them. Anyone else have the same insurer?
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