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-   -   My Workers Comp. Ins. Will Not Cover My Bone Density Tests (https://www.adrsupport.org/forums/showthread.php?t=7789)

Eddie_G 07-22-2006 12:11 PM

I had concerns since both my Father and my Uncle had Rheumatoid Arthritis so I asked my disability nurse about a bone density scan. She won't cover it and Dr. Goldstein doesn't think it's even a necessary test since I'm only 38. (I can only assume that since I heard it second hand from Doc Goldstein's assistant and not from him) Usually people over 50 get the BMI test.
I am going to get the test anyway using my primary insurance just to be on the safe side. I hope that by using my regular insurance, it won't cause problems down the road concerning future Workers Comp payment/responsibility. It took alot of fighting to get to the point I'm at now of waiting for Prodisc approval with Dr. Goldstein. (which is not a bad place to be)so I dont want to do anything to rock the boat. I just hope that even mentioning my concern about my family's medical history won't hurt my WC case.

I also feel that I wouldn't need this BMI in the first place if my company wasn't so irresponsible and I didn't hurt myself on the job. I have a 20.00 copay on my regular insurance (Aetna) I wonder how much I would have to pay out-of-pocket for this bone density scan? Anyone else with Aetna?

In the meantime, Is there anything else I can take besides calcium, B Complex, Vitamin D, and even Boron?

Am I doing the right thing by getting this test on my own? Can this effect my Workers Comp case in NJ?

chasswen 07-22-2006 02:10 PM

well eddie
i think i would want a dexa scan at least with adr
if you were in or going into a fda study or even if you were to go overseas they would want some type of bone density test.
chuck

Mariaa 07-22-2006 04:16 PM

No matter the age, no matter the gender, I'd want a Dexa Scan for Bone Mineral Density done as well.

You mentioned your family has a history of Rheumatoid Arthritis~ I think this shouldn't affect your WC case but medically you would want to have a Rheumatoid panel done if you've not already and see about seeing a Rhematologist if not done so already. Rheumatoid arthritis is an autoimmune disorder so probably more part and parcel of your medical care vs. WC.

Usually it's Osteoarthritic changes that happen with spine degeneration such as wear and tear changes. That sometimes WC disputes as it's difficult to calculate the change that would naturally have occured vs. what has happened because of a work related injury.

My issue with this is that the degenerative process in my spine has been hastened by the two discectomies I had that were the result of a work related injury so, in my mind it's all related to the work injury, in a way.

Loss of bone density (softening of the bone)is something that males and females endeavoring to have spine surgery such as fusion or ADR should care to have checked out as sometimes there are significant surprises in terms or results that one would not necessarily suspect otherwise.

Low bone density or very soft bone, bone that is osteoporotic is something that one would want to know about before entering into these surgeries.

IMHO you are within your medical rights to ask your medical insurance to authorize and perform this exam. I had to do so as WC also denied authorization for this exam for me as an potential ADR/fusion hybrid candidate even tho I am 52 with a family history of osteoporosis and osteoporosis in both hips and osteopenia in my lumbar spine. In this sense yes, it is an existing medical health issue for me and my medical insurance would normally pay for the exam.

If you are young and male I can see why the WC insurance might not want to cover this request, even medical insurance/doctor might not think you require the Dexa Scan prior to this surgery although I think it's a good screening test and should be performed before such surgery as ADR and fusion routinely.

Good luck~ ask your PCP (primary care doctor or General Practitioner, Family doctor, or Internal medicine doc if you have one) about ordering the test.

cathydownunder 07-23-2006 12:19 AM

Eddie
I had a bone density scan a month before my ADR. I requested it (age 45) although my surgeon didn't think it necessary. It showed the spine to be good but my hip is osteopenic (pre osteoporosis). Both my mother and grandmother had osteoporosis.
Because of my age I had to pay the full cost, about $90 Aus.
I've been taking a calcium, magnesium, Vit D supplement for years so I was disappointed with my results. I'd also like to know if there's anything else that will build up bone density.
Cathy

Harrison 07-23-2006 07:23 AM

Eddie, issues on bone density often arise in discussion (as they should!). Trace was kind enough to aggregate most of these previous discussions into an FAQ, see here:

http://adrsupport.org/eve/forums/a/t...1/m/2241054281

Hope this helps.

luvmysibe 07-23-2006 11:00 AM

regardless of your age and/or overall health, it is a wise idea to request a bone density and bone mineral scan. I have had three within the past 10 years and am glad to report that some of my loss has been reversed. After my initial scan, I took Fosamax, but I couldn't endure the side effects. Since then, I have focused on strength training, eating plenty of fruits and vegetables and taking all natural, plant based supplements through Standrad Process. I too was a WC case and was cautioned about using my own insurance for procedure related to my spine that WC wouldn't cover. I did pay for some of my own water therapy and chiropractic care because it was vital to my progress and pain management.

Eddie_G 07-23-2006 11:21 AM

Quote:

I too was a WC case and was cautioned about using my own insurance for procedure related to my spine that WC wouldn't cover. I did pay for some of my own water therapy and chiropractic care because it was vital to my progress and pain management.
Cautioned by your lawyer?
I go to massage therapy that my WC won't cover and my lawyer had no problem with that.
I go to my regular Dr. for Testosterone replacement therapy. I will ask him to authorize the BMI test since the Testosterone could have some positive effect on my bone density.
(I am on Testosterone because my levels were too low as in 21. My levels now are around 800 which is normal.)

I guess I'll have to call my lawyer Monday too to cover all bases. (eh) He may caution me too! Then what do I do? Fight for WC to pay for the BMI test? It was such a battle getting my ADR approved by a competent NY surgeon. Like I said I don't want to rock the boat but what were you cautioned about? Is it worth it for me to cause a fuss?

I've been reading all the info just thrown at me and haven't had a chance to say thank you so THANK YOU ALL!!!!! This is great stuff!

Mariaa 07-23-2006 07:16 PM

Long ago when before my WC award (back in the '80s) I was also cautioned about using medical insurance but it was for treatment because if I had any unauthorized treatment such as surgery or invasive intervention not ordered by the WC doctor/surgeon, that was considered going against what WC Primary Treating Physician had ordered for plan of care.

Getting a Dexa Scan test is acutally more related to preventive medicine and ruling out a condition that one may need medical intervention for in the way of medicines that are prescribed, use of Calcium supplements, dietary changes, weight bearing exercise and so forth..

Hoping you won't have a problem with this at all.. keep us posted~

spotty14 07-23-2006 10:39 PM

I'm surprised that your ADR surgeon isn't ordering the Bone Density scan. I was all set up in an ADR clincal trial only to find out that I had very severe osteoporosis and was no longer a candidate. ADR surgery then would have been a disaster. It's definitely worth doing - do you have a PPPO plan on your private insurance where you can go to a specialist to get an order?

Eddie_G 07-24-2006 08:30 AM

Quote:

Originally posted by spotty14:
I'm surprised that your ADR surgeon isn't ordering the Bone Density scan. I was all set up in an ADR clincal trial only to find out that I had very severe osteoporosis and was no longer a candidate. ADR surgery then would have been a disaster. It's definitely worth doing - do you have a PPPO plan on your private insurance where you can go to a specialist to get an order?

I wish I would have known about my Uncle's and Father's rheumatiod arthritis condition BEFORE I went to see my surgeon. I have no appt. scheduled for my surgeon until the Prodisc is approved so I would have asked about it when I had the chance. It seems to be a common test so it does make me wonder why Dr. Goldstein did not order it. (Maybe my discogram told him something, I need my discogram report)

I am going to use my private insurance to get this test as long as it wont affect my WC case.


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