Kelly,
Here's the synopsis of my four rounds with BCBS-TX.
- Submitted claim
- BCBS - denied as not medically necessary
- Submitted appeal showing medical necessity
- BCBS - denied as investigational
- Submitted appeal showing almost 1000 years of clinical data
- BCBS - denied stating that approval was against company policy
- My employer objected to the absurdity of "company policy"
- BCBS - denied stating that the contract allowed them to deny if I went out of US
Thanks for the update and keep on them. Insurance companies seem to be drifting away from the trend of "deny for any reason", as demonstrated in my case by BCBS-TX.
Good luck, Jeff
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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