Thread: Final appeal
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Old 08-02-2014, 12:01 PM
Kelly4ADR's Avatar
Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
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Thanks for your prayers Mike...as this week approaches I'm a bit rattled. I will have surgery either way, if it is still denied my insurance will pay for 1 level and I'll pay for the other, about 16k out of pocket, but it's the principle for me...I deal with insurance with my massage clinic and we are seeing denials come across more and more for very non legit reasons. It's a delay tactic that really makes me mad. I have to spend more and more money to have my staff push papers back and forth to get even massage tx paid. I personally have put off surgery for many many years, for them to tell me now that I can't be allowed what I need? Frustrating is an understatement...and I feel like we owe it to those coming up behind us to fight to get approvals and pave a path for them. Insurance has to be consumer driven as much as we are able or it will only get worse. Wow, sorry for the rant as I look at this big paragraph lol. Enough about that!

If you are considering switching surgeons, look up Dr. Richard Wohns is Puyallup, Wa. His clinic is Neospine. He is my surgeon. If you are in Idaho he isn't all that far from you and worth the travels. He is in south Wa, I am north Wa and it takes 2-2.5 hours for me to get to him but he is truly an expert in this area. If you look up his credentials it is impressive. At least he could be another opinion for you. They are also very pro-ADR and will work on your behalf to help with insurance approval.

I have never had a discogram but I've heard they are not fun. But I've also heard they are a valid test to conclude the source of symptoms. Hobbes1212 has had 3 cervical ADRs done by Dr. Wohns (1 in one surgery and 2 in another). He performed discograms on her to validate. I feel that if he uses this test, it is valid as I trust him very very much. But, maybe he would have another suggestion as well, he is the expert. He may even do a review of your films without having to travel over. There is another poster on here (CDW...) who is in NY who is sending her stuff for his review I believe. I also got opinions from overseas Docs, Clavel and Bierstedt (sp?) who will review your stuff for free. The more opinions you can get, the better.

I hope this was helpful
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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