Florida Blue / authorizations - see attached pictures
See attached pictures... Complaint previously sent
Please help! I am disgusted and heart wrenched over the guidelines and protocol of florida blue insurance company. I am also baffled that florida blue insurance company can deny a request by a doctor regarding a patient's care. The following is an explanation per our telephone conversation. My surgeon, dr. Devin datta's office put in a request to bcbs for me to have back surgery on 10/18/2017. On or about 10/11/2017, I was informed by dr. Datta's office that bcbs denied my surgery. I was also informed that every patient that has gone through their office with this insurance has been denied for some reason or another. Dr. Datta scheduled a peer to peer, which was also denied. I contacted bcbs myself several times before I was able to get answers. At first, I was told that it was approved, I was given a reference number, codes, and dates of service. After contacting dr. Datta's office back, they informed me that the codes and authorizations that were given were for the hardware that was going to be used in my surgery. After contacting bcbs again and asking for a supervisor, I was connected with jennifer trout. Jennifer told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I explained to jennifer that I had back surgery in 2013 and 1 in 2014 and had 2 rods in my back already. Last year before my visit with dr. Datta, my neurologist ordered a ct myelogram, which is an extensive test showing results or damage around the hardware in my back and previous surgeries. It took me 5 months to get into dr. Datta's office. I had therapy last year before I went to dr. Datta and the ct myelogram.in july 2017, I had a spinal stimulator trial put in my spine with the hopes that it would work and I could avoid surgery. Spinal stimulator: a type of implantable neuromodulation device (sometimes called a "pain pacemaker") that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. Scs is a consideration for people who have a pain condition that
Has not responded to more conservative therapy.
Unfortunately, it did not work. I have been out of work since last november, no income whatsoever, homeless (staying at a friend's house for now), and I have $75 copays every time I go to therapy or surgeon. My help from people is running out.
In my last conversation with jennifer, she told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I have complied with everything. I had an mri, my last cigarette was october 11, 2017, I have been to therapy a few times which is not helping, my bmi is lower, because the weight the doctor's office had was the weight I gave them 265lbs. I actually weigh 249.5 lbs at the present time. I also had the spinal stimulator trial, which would be considered another "conservative therapy" before surgery. I had an appointment with my primary doctor, so everything is documented. If I need to be tested for nicotine, I have no problem complying, but I continue to wear the nicotine patch.
Last week, my surgeon's office resubmitted a request with updated compliance for authorization for the same surgery on levels l2-l3 and l5-s1. The surgeon's office contacted me to inform me that florida blue is now approving l5-s1, but is denying surgery on level l2-l3. This morning, I contacted customer service once again, only to be told that they have more stipulations.
The surgeon's office said they have denied surgery for almost every patient on the same insurance. How can they get away with this?
D. O. B. 12/29/1967
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