Surgery Date Set, But Will Insurance Pay?

[Nairek]

So, after having an SI joint injection and a 3rd, yes a 3rd discogram, I have made a decision with regard to surgery.

The SI joint injection was a diagnostic injection of numbing medication & was only about 20% effective in relieving my pain. It's a good thing the pain mgmt. dr. had good reflexes. Poor guy was close to getting punched out when he pressed on the SI joint after the injection.

My 3rd & most painful discogram, it was positive at L5/S1. I told the OS that my last 2 were positive at the same level but he wanted "his guy" to do it.

I have steadily spiraled downward with my back since the summer. The last discogram has left me in constant discomfort with more pain than I am use to.

I am scheduled for surgery on January 20th in NYC. The type of surgery will depend on the facet block that I will have on Monday. I want a disc replacement but as I understand it, if the facet joints are causing the pain, I would have to have fusion.

Now the interesting part. I am waiting for his office staff to get me pre-certified through No-Fault and my private insurance. I was assured by his staff that the hospital will not allow the surgery to go forward if I don't have the pre-certification.

Talk about being on edge..... :puke:This should be an interesting few weeks. I know it's a little too soon, but the reality of it is starting to hit me.

I'm keeping my fingers crossed & hoping that things will work out for me this time. I don't know if I can go another round with the NYS Dept. of Insurance.

[Harrison]

Karin, sorry about the latest nail-biter chapters (and also the part that the emoticon so wonderfully expresses!). Regarding the pre-certification, are they certifying the procedure and your appropriate condition for certain procedures? It sounds tricky.

And from what I've heard and read, arthritic or compromised facet joints could be a huge risk factor for ADR. So that sound logical to me.

Good luck tomorrow! Don't punch too many people! :eek2: And let us know what you hear from the doctor's office.

[Nairek]

Yeah, leave it to me to have an interesting life.

Originally, it was hoped that I would have the facet block done before my pre-surgical testing on 1/8. Problem was, the pain mgmt. doc only had an appointment available for the same week as my other testing. So it is possible that the pre-certification hasn't started yet.

The doctor's office is aware that I want ADR. Their billing manager assured me that she would do everything in her power to get me approved for ADR surgery. If it fails, then the decision is up to me to do nothing, go for fusion, or pay for ADR out of pocket. She told me that they would work with me on this.

Now what I'm curious about is why neither of these 2 NYC OS's said anything about my SBO. I had a few docs point it out to me on x-rays & sure enough, there is a small patch of bone missing. I'll have to remember to ask his PA if he agrees with that diagnosis & see if that's a problem. I've been told that it wouldn't disqualify my from ADR. I'd rather be safe than sorry.

I don't think I'll be punching anyone out tomorrow. I actually like the pain mgmt. doc. Poor guy is always getting grief from me by either pulling away in pain or getting "owww owww owww" yelled at him. He has to be one of the nicest docs I have ever met. A real wise guy too = )