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Charlotte's complaint:
November 26, 2012

Insurance Company: Blue Cross and Blue Shield Association
Coverage Type: Health Insurance

  • PolicyHolder Service - Denied Access to Services
  • Claim Handling - Denial of Claim

I was scheduled to have surgery on Friday 11/23/2012 for spinal fusion and a discectomy. This is after MONTH of visits to doctors, chiropractors, massage therapist and physical therapy, not to mention acupuncture treatments. I am in desperate need of this surgery and Anthem BLUE CROSS/BLUE SHIELD DENIED it saying it was not medically necessary. I have been suffering from sciatica in addition to the back problems for over 11 months now.
For 8 months, I have been on daily Vicodin and Percocet painkillers just to be able to function (somewhat) as I need to work to support myself, and my family.
Over 4 medical doctors, including Dr. Gregory Munson at JEWETT ORTHOPAEDIC have deemed this medically necessary and yet it was DENIED the day before Thanksgiving with no recourse but to cancel since we could not get anyone at BC/BS to give approval because of the holiday.
My holiday was spent on the floor, in great pain. My family has to watch me suffer to walk, to stand, to try and bend (which causes me to usually fall) and more.
I find it highly outrageous that BC/BS will continue to pay to “drug” me on these painkillers but will not approve surgery which is my LAST OPTION. I wonder if BC/BS will pay if I am in a drug induced auto accident? Will they cover the innocent victims, if I plow into someone because the drugs make me so sleepy I can hardly see sometimes? And please don’t tell me I shouldn’t be driving or working---I have no alternatives and yet they see fit to deny my the only treatment that will make me better.
They have also denied my second request from Dr. Suresh Kannan to do another series of epidurals and or a nerve block, which provided temporary relief and would have helped at least postpone the necessity of having surgery NOW, but BC/BS is obviously not interested in getting me well—they just want me to go away. I am not going away and I demand that you do the right thing NOW and approve this surgery immediately.
Copies of this letter are being sent to the Insurance Commissioner’s Advocate Office in the State of Florida, my congress people and senators, the Governor’s office and BC/BS. Somebody MUST advocate for me with regards to this situation. I am also posting this on FACEBOOK, and sending to the Orlando Sentinel.
If it was your Mother, your sister, your wife in this much pain, wouldn’t you advocate for them? I am somebody’s Mother, Sister and wife and I deserve better treatment from Anthem Blue Cross/Blue Shield and I will not stop until I get the surgery I so desperately need.

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