State-Hopping for Investigational Procedure

Hello everyone,

I've been unable to find an insurance policy in my current state of residence that doesn't consider my upcoming surgery (CPT code 22857), investigational.

Currently, I have a direct pay PPO with Blue Cross Blue Shield of my state of residence. Because they don't cover the procedure, I'm researching the process of changing residencies to Florida and acquiring a plan there. I have already read the medical policy here.

Florida Blue's medical policy regarding CPT 22857 says, “Lumbar total disc arthroplasty meets the definition of medical necessity when ALL of the following are met:”. It goes on to list the indications and contraindications of the surgery. It makes no mention that the procedure is investigational, which my current medical policy does say.

My plan as of now is as such:

Fly to Florida with a certifier of address. Use the CERTIFICATION OF ADDRESS form to prove residency. Get a Florida driver's license (2 weeks in mail after form is submitted) Cancel current insurance plans triggering a loss of coverage qualifying life event, thus enabling special enrollment. Use Florida's driver's license to enroll in a direct pay PPO with Florida Blue with a coverage start date of August 01, 2024. This plan would have a high premium and low deductible because I will only have it for a few-several months and know the surgery being performed. If the premiums are less than the deductible, this makes sense to get a very expensive plan. PPO because I want out-of-state coverage when I come back to my current state-of-residence. Get new ID mailed to the Florida residence sometime after payment of first premium. Get surgery whilst having Florida Blue Gold/Platinum PPO coverage.

Additional considerations:

I am eligible for Medicaid in Florida. I don't know if Medicaid would cover this procedure, but I believe it would, along with the vascular surgeon, anesthesiologist, and facility.

Is this reasonable? What am I missing?

submitted by /u/nPsyntax
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