Don't Seem to Have Doctors Support

[D. Hollingshead]

I have been with the same Treating Doctor and Orthopedic Surgeon , Pain Management etc for nearly 2 years. I have had 3 discograms, identifying L4-L5 as the pain generator, and L5-S1 as questionable, however, it sure is painful, as if I was kicked in the tailbone, really sore ALL the time much lower than the L4-L5. Lifting, and sitting are very painful...like pushing the grocery cart, I don't even try to carry the bags.
I've had several SI injection's, with minimal relief..so my surgeon suggest, ADR.

Okay, after several month's of dragging my feet, and not KNOWING if my pain is bad enough to endure a spinal surgery I agree to it...The Doctor sends off the request and includes information that is over a year old ???, not the most accurate, W/C denies the surgery, the treating doctor dictates an appeal nearly 4 weeks ago. I find out today, the appeal is sitting in my chart, NEVER sent..so the window of opportunity for an appeal has passed and my appeal will now be sent to the Medical Dispute Resolution department for a hearing...

I don't know what to do, It seems like this office never get's it right, and the attitude I got from the Treating doctor was not so pleasant, as IF I had done something to create the problem. I had asked to see another surgeon in the same office, this seem to stir the pot some I suppose. But I am not feeling comfortable with the surgeon who I have been seeing, he has no bedside manner.

It's hard enough being in pain, second guessing what I should do, making that decision just to find out the doctor's office doesn't seem to put enough effort into getting it right.

I need a new doctor in the Dallas Fort Worth area, who is experienced with ADR. and focus's on the patient and THERE well being.

Any and all suggestion's would be welcomed, my w/c case manager is already setting up a second opinion with a surgeon in the Dallas area. She has been a great advocate and cannot even believe the inconsistancy's that have occured..

Thank You

[JoJo]

I am going to be no help whatsoever, but I can sure offer a ton of sympathy. I had a very similar problem with my first surgeon, who suggested ADR as a solution to my problem. It wasn't so much the doctor, but his office staff that was unhelpful. I got so that I would give them a week to do what the doctor asked, and then call back to check to see if it was done. When the doctor said that I should have ADR, and was a candidate, I called after a week to see if they had sent in the paperwork, and the staff person told me that "insurance companies aren't paying for it anyway." It eventually got submitted, and went to appeal, at which point I was denied. My breaking point came when I called the doctor's office to see what else could be done in JULY and was told that his next available appointment was NOVEMBER.

I then changed doctors, got several more opinions and ended up having a fusion. We messed around for 2 years with the first doctor. I wonder now if I had had the fusion done 2 years ago if the nerve root damage would be as bad as it was when I finally had it done.

I'm not advocating fusion or anything else for anyone else. It's been a long, hard row. But I am ever so slowly getting better.

Good luck in your search for a new doctor!

[Mariaa]

It's really infuriating that the office left the request sitting w/o action for so long.. are you still in litigation re WC? My WC has been thru lifetime future med benefits the last 20 years or so and my OSS of the last 8 years has been good about sending off requests for authorization, just doesn't want to do 2 level ADR tho right now he says that because WC in CA is the way it is with everything going thru UR and very little surgery even being authorized, that only a one level ADR would be auth'ed and one level fusion.
I wonder why the reason was that request got left sitting .. holiday season, ineptitude,.. other..? Whatever, the attitude of the Surgeon would likely be protective of his staff esp. if they've been there a long time, or so I've heard from others that had unsatisfactory experiences with office staff and reported it to doc. Either that or an apology would be rendered about how the office is reorganizing and things are getting waylaid, lost, sorry, excuse us and so forth.

I'm sorry you didn't receive a sincere apology and offer to try and right the wrong or take responsibilty for office error (may be impossible now to right wrong w/WC deadlines w/o attorney assistance)..

Good luck with finding an new doctor with a very well organized office that works expertly with WC and YOU foremost..hope this is easier done than said...

[Dale S]

Okay, here's my opinion. You only have one body and one lifetime to use it. It's yours to do with as you so see fit. If you don't like a doctor or question his abilities, you OWE it to yourself to get a better one.

I'm sorry I don't live in your area to recommend someone, but I wouldn't stay with this doctor one more minute

Good luck, Dale

[luvmysibe]

Hi Dede,
Listen to your case manager and your inner voice that says, "This isn't right." Request a second opinion and then from there request to change your treating physician. I did this with my WC case because the first orthopedic surgeon said I wasn't a candidate for surgery at all; within 5 minutes of being with my current specialist and I was the ideal ADR patient. Request copies of your reports and images if you don't have them already and be prepared to take them with you. If your current doctor's office is unhappy about you transferring your business elsewhere, they may be slow at forwarding your file. Hope this helps!