pain

had an accident in 1997 and suffered from back injury among other injuries,developed chronic low back pain, went to pain clinic ,on long term narc, and yearly as part of pain management get aprox 3 facet blocks per year and phenol rhizotomy on rt and lt lower back..after about 6 yrs this past year the b/c b/s insurance refuses to pay saying not medically necessary, even though has kept pain under control and they were supplied with medical doc. whats the problem?

[SLCPMOM]

Dear stix,
I will tell you as of January 2001, BCBS has changed their policy regarding Diagnostic medial branch blocks (same code as Facet injections) and Radiofrequency Ablations (Rhizotomy).  I will tell you it all comes down to documentation by the physician.  I can help you with this but unfortunately I cannot do it on an open forum.  If you would like further information, please message me.
By the way, it primary changed for BCBS HMO plans.

[SLCPMOM]

Dear stix,
I will tell you as of January 2001, BCBS has changed their policy regarding Diagnostic medial branch blocks (same code as Facet injections) and Radiofrequency Ablations (Rhizotomy).  I will tell you it all comes down to documentation by the physician.  I can help you with this but unfortunately I cannot do it on an open forum.  If you would like further information, please message me.
By the way, it primary changed for BCBS HMO plans.

[SLCPMOM]

Stix,
Sorry, there was a typo, it's January 2011.

[stix223902]

I dont know how this works .. not very computer literate .. but am I in the right spot. The hosp. sent doc. but still they said not medically necessary did a rt and lt phenol rhizotomy and have been having done yearly and insurance has pd for it. What do they want. I have asked for an appeal as they have asked ins. x2 and wont pay . Help! If this is where I am to put my e-mail please tell me I dont know am desparate as the bill with anesthesia is upwards to$ 20.000. and husbands job has just been cut to 20hrs a week after 15 yrs.  stix