BCBS denied pre-auth for my spine surgeon's recommended ALIF because they want me to try 6 more months of PT first. I've already done 18 months of PT and 3 epidurals. What now?

Quick background. Two herniated lumbar discs (L4-L5 and L5-S1), radiculopathy down my right leg, foot drop intermittent for the last 5 months. MRI is unambiguous, EMG confirmed the nerve involvement, my surgeon and a second opinion both recommended an ALIF (anterior lumbar interbody fusion). Ive done 18 months of physical therapy across two different clinics, 3 epidural steroid injections, two rounds of oral steroids, gabapentin, you name it. Surgery scheduled for late June.

Got the BCBS pre-authorization denial yesterday. Reason: "patient has not completed 6 months of consecutive conservative treatment within the past 12 months as required by medical policy guidelines." I have done conservative treatment continuously for 18 months. The records are voluminous. But because i had a 6 week gap in PT last summer (i went on a long planned family trip and could not attend sessions), they are restarting the clock and demanding 6 more months from now.

Im honestly stunned. My right foot is dragging when im tired. My surgeon documented the foot drop on the last visit and noted progressive motor weakness. He told me yesterday he is genuinely worried about permanent damage if we wait another 6 months. He also said this is the third BCBS denial he has seen this month for the same reason and he is starting to think its a policy push from above.

What are my options here? Peer to peer review with my surgeon was scheduled but BCBS rescheduled it twice. External review through the state DOI? Can my surgeon document the progressive motor weakness as an exception to the conservative treatment requirement? Im 41, i have small kids, and i cannot lose the use of my right foot because someone in a cubicle wants 6 more months of paperwork. Anything that has actually worked for people would mean a lot right now.