UHC = Stress
 

My name is Becky. I live in Wisconsin and currently trying to fight UHC to approve ADR before the end of the year (2011).

I have been living in chronic back pain for about 7 years now. I have a single level DDD at L4-L5 and currently fighting with UHC to get them to approve ADR.

Today (9-12-2011) I had a conference call between UHC, myself and Lindstrom Advocacy I think it went pretty well, but who knows. They denied it a month ago because of being "experimental" and "un proven" I guess they also denied it because they stated that i have DDD in another disc and can't prove that L4-L5 is the cause of the pain. Well with out getting to in-depth L4-L5 is about 1/4 the normal size of the rest of the normal discs and they think that L5-S1 could be an issue because the MRI found a very small tear in that disc. (COME ON YOU LOOK AT THE MRI AND YOU CAN TELL WHICH ONE IS GIVING ME ISSUES!!!)

So we are fighting UHC and hoping to get it overturned so I can get ADR in November 2011. FINGERS CROSSED.

It floors me that being 30 years old, living with DDD for 7 years, living a healthy active lifestyle (Ive been involved in gymnastics for 16 years) the insurance company can say no to a procedure that more then 3 doctors have recommended would help maintain the quality of life.

ahhhhhh insurance is so stressful!

anyone have success with overturning a denial from UHC?
I have met my deductible for the year and really need to get this overturned by the end of the year!

have no experience w/ UHC.... but, i do have a question - have you had a discogram? MRI's do not always correlate with symptoms. a bad disc isn't always symptomatic, and a disc doesn't have to look terrible to cause pain. just something to ask your doc about... might help your case.

i've had 2 and well... they totally suck, but definitely gave me and my dr's confidence that we were just dealing with 1 bad disc.

i'm also young - 33 - sorry you're also having to deal with this when everyone else is out building their lives.

I have not had a discogram. Not exactly sure what that is.
But I have been told by 3 specialists over the last 7 years, that with in 10 years I would be having major surgery (fusion or disc replacement) my disc is also bulging and it is pressing on the nerves which I have been told is causing my pain.

UHC stated that they are not sure if ADR is the right choice because in the MRI it showed a tiny tear in the disc below. But the doctor did state in his notes and i quote verbatim "She has a single level degenerated disc at L4-L5. There is loss of height and darkening of the disc. EVERY OTHER DISC IS ABSOLUTELY NORMAL. AND SHE HAS LITTLE IN THE WAY OF FACET MEDIATE CHANGE."

So UHC saying that they don't know if the disc below is causing the problem is absolutely wrong. I wonder if I have had any issues with this second level why hasn't any doctor every told me. and UHC denied it because they think it could be an issue. but then again I'm just ranting!

but I will most certainly check out what it is and see if it is something that would help the insurance company make the correct decision.

question, what can a discogram tell the doctor? I just assume that the doctor ordered ADR because of what the disc looks like and how it has changed over the last 7 years. But then again I have no idea.

i'd google "discogram" for more details about the procedure... it's a test that allows your doc to know which of any abnormal discs on mri or other suspected levels are "pain generators"... the idea being you don't want to operate on an asymptomatic level or miss a level that doesn't look so bad in MRI but is causing a lot of pain.

my L5/S1 disc doesn't look awful on MRI - and it made other docs miss my diagnosis for years. once i found a good interventional pain/spine guy who actually listened and put the picture together, and looked more closely at my mri... i ultimately had a discogram that confirmed that my pain was coming from that disc, and also that i had a big ole annular tear (of which there was just a hint on mri).

some people will tell you it's the worst thing ever. i won't lie - it SUCKS - and i've had TWO, and i'm still alive/walking/continent. make sure they're gonna med you up well after and don't do anything but rest for 3-4 days after. i tried to do too much after my first one and learned my lesson.

Hi Becky, I hope we can help. Here's a helpful, albeit crusty FAQ on discographies:

http://www.adrsupport.org/forums/f49...i-expect-7979/

Pls take the time to read all the topics, as they should answer most of your questions.

That said, bear in mind that these procedures do introduce risks and may negatively affect the health of an already immune-compromised spinal disc. I've met spine surgeons that continue to maintain that position, though they seem to be in the minority.

thanks guys, ill look into it.
Im not sure if i want to do another procedure that will cause pain (the spinal injection was horrible!) but i guess ill wait until next week and if UHC says no again then ill be talking to my doc on where to go from there since i will not do fusion being 30 years old!

thanks

Harrison -

the majority of spine surgeons won't operate on a young person w/ a non-horrid MRI w/o clarification w/ a discogram - and they probably shouldn't. i know that in my case, i have 2 types of pain - myofascial and discogenic - but it took time and experience to know the difference. to have anything invasive for myofascial, or facet, or "other" pain... is imho part of why some spine procedures fail, and why some of us have trouble accessing one treatment or another.

Ok so update...

UHC decided to uphold the denial :( really bummed today. I had a good feeling about this one. too bad their expert was a guy that graduated from Med School in 1965 oh and to make it better... he is a pediatrician. Ok so i guess i am mistaken for much younger but COME ON, a pediatrician that has nothing to do with ADR.

so frustrated i want to cry.

on to the independent review appeal

Becky,

Condolences on the predictable decision. A pediatrician? That the insurance company "expert" wasn't an spine or orthopedic specialist is ... also predictable.

Wishing you the best of luck. What's next?

Jeff