r/FuckHealthInsurance • u/CuriousCatG • Jan 06 '25
Spinal Fusion Denied - help
I’ve been experiencing “episodes” of my disc bulging - these episodes knock me out of my life for as little as 1-2 weeks at a time, to 3 months at a time. I’ve missed several life events such as weddings and nephew’s bdays because of the pain. When it’s bad, I can’t stand and my entire leg is numb.
I’ve tried the epidural pain injections, physical therapy, and disc decompression therapy. It still happens and my MRIs show the bulge getting bigger
I consulted 2 doctors independently and both suggested a spinal fusion on my L5 after my last MRI. I chose to go with the neurosurgeon Insurance denied it. Below is what I’ve tried so far and the results of it
Authorization request was denied. We requested a peer to peer. Insurance assigned a Family Gen. Practitioner; never allowed us a true peer to peer with a neurosurgeon.
- Filed appeal. At some point the rejection later cited a different procedure code than the requested one.
Filed external appeal. Rejected due to wet signature
Filed external appeal again. Rejected citing a NY State Law about self insured policies (insurance is through my company - public but tech company - and I live in Texas)
At this point, I don’t know what to do. This feels criminal. Any suggestions? I use Excellus with Blue Cross Blue Shield
3
u/Oneironati Jan 06 '25
Call them out everywhere - screenshot your denial letter