Opinions on Blue Cross Blue Shield as an Insurance Company

I started having back pain over 4 years ago. At first it was a nagging pain which I could control with medication, but, like many people with back pain, it got worse and worse. It got to the point that it was affecting my daily life. The side effects of medication caused sleepiness at work, which was not well received by management even after explaining the situation.

So after a year of dealing with the pain, I found that I had a disc that had herniated and protruded into my spinal cavity. To boot, I found I was born with Spinal Stenosis which is a condition where your nerve roots are smaller than a normal persons. That said the herniation and Degenerative Disc Disease compounded the pain I have from the Spinal Stenosis.

I got to the point that I was walking with a cane and severe limp, and was unable to straighten my legs due to terrible nerve pain shooting from my waist down my legs to my feet. I was in and out of the hospital, to trying to control the pain when it got so bad that my normal medication could not help. After one of these episodes my Surgeon recommended that I have surgery to trim the piece of disc that was protruding onto my spinal cord. I would have done anything at that point to stop the pain, and so I agreed to go ahead with the surgery called a Discectomy/Laminectomy.

The surgery helped for all of a week before the Disc had moved right back into the spot it was prior to the surgery. So there I am, in my late 20’s unable to go to work without the support of a back brace system and a walker. Unable to perform simple tasks, like dressing myself without assistance.

My Surgeon and I discussed my options to try and get some relief from this pain that was uncontrollable. He recommended that I have a total Disc replacement, and that I was a textbook case to have the surgery. He then followed up with; “What insurance company do you have?” To which I responded “Blue Cross Blue Shield” (BCBS) and he replied “hmmm… good luck with that one!” He said that the few people he had recommended have the total disc replacement, and had BCBS ALL of them were declined coverage for the surgery.

There is a 3 step appeal process to which you can appeal the decision made by the insurance company. First a formal appeal to the insurance company to which I received another decline of coverage. The reason stated on the letter was that the procedure was too investigational. (even though the FDA had approved the procedure for use in the US) Second another appeal to the insurance company, with your Doctor’s professional recommendation. Which was again, declined but this time stated that there was no proof that this procedure was “Better” than other procedures that they do cover. Third you appeal to a governing body controlled by the state.

Have you ever wondered WHY these insurance companies are out of state? You may live in Chicago and have BCBS of New York. This is a way for the insurance company to avoid being governed by a state board which would normally hold a hearing and decide whether or not the insurance company HAS to cover you.

If you are wondering what my other option is, it is a fusion. The problem with this, is that due to the way a fusion is performed, the disc immediately above and below have to take the force of the disc that no longer exist. I was told that it was only a matter of time before I would have to have another surgery. Due to my age the best option was an artificial disc because there was a better chance that I may not need surgery again in the future and I will not lose the rage of motion that I would with a fusion. As well, I could still have a fusion if the artificial disc did not help.

So in closing pay attention to where your insurance company resides. They are there to make money and the more people they can decline coverage to just adds to the fat pockets that their uncaring Doctor’s walk around with. The doctors get a stack of approval request and even after never having met you, having never contacted your doctor, make a decision that can affect the rest of your life. I have since changed insurance companies and am currently in the process of being declined here as well… maybe the article should read: “Why Insurance Companies are Lousy!”