Re: ADR Denial/Appeal
Don't have any idea what the doctor's provide regarding appeals, but if you can submit your own paperwork, perhaps you can summarize with the fact that doctors submit that fusion puts additional stress on the levels immediately above and below the fusion. That the ADR will most likely prevent the progression of having to undergo additional surgeries, hospitalization as well as be a major factor in allowing you to remain actively employed. Dollar wise, depending on where you are located, if it saves BCBS from paying for say a 3 level fusion in the next couple of years, they could save themselves from paying a doctor about $60,000-70,000 in surgical fees and about that much more in hospitaliation, plus another $25,000 or more for the BMP that is used, and don't forget all the fees for other doctors involved in surgery, and that doesn't even count all the thousands they will pay out for additional MRI's and office visits, PT, etc leading up to the decision that more fusion is needed.
Since they are more about money than they are about helping people or even doing what is right, perhaps something along that line would get their attention. Best wishes for approval very soon.