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Old 09-28-2011, 04:44 PM   #1
Senior Member
Join Date: Aug 2011
Location: Jacksonville, FL, USA
Posts: 115
andrea32225 HB Userandrea32225 HB Userandrea32225 HB User
chronic pain thanks to BCBS!

I just wanted to vent a minute re BCBS. I was supposed to have an L5-S1 TLIF on Tuesday, and the doctor wasn't notified until Monday of the denial. The peer-to-peer review didn't even go through - they said there wouldn't be enough disc removed to caused back stability (I had a MED at the same level in July w a lot more damage than the surgeon thought).

The urgent review on my end has been submitted and I should know by about 4 PM Friday. I found peer-reviewed literature showing that a fusion versus a repeat MED was the best option - actually 3 cases of that - and submitted it in a very well-written letter. I just pleaded to them and told them I didn't want to be a narcotic pill-dependent bedridden (as I am 95% of the time now) 38 year old.

I'm also going to have to miss my son's HS graduation in May w/o any treatment because there's no way I could travel (6 hrs), and I took the full 12 weeks FMLA Leave, giving me 2 xtra weeks of recovery beyond what the surgeon thought was necessary. I can't even do a clerical job now! So, I'll probably lose my job too, all because of some darn pencil pusher.

Oh yeah - piece of advice - if you ever have to call BCBS, be prepared for a never ending voice mail system where you are lucky to get a person 5% of the time.

Thanks for letting me vent. Needless to say, I'm angry, depressed, very emotional, and nerves are shot. Parents were supposed to come down for the surgery, but now we don't know if their schedule will allow. Besides, what a freaking way to spend my birthday Saturday - drugged up and in bed.

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