View Single Post
  #1  
Old 01-16-2011, 04:36 PM
MustangO3 MustangO3 is offline
Junior Member
 
Join Date: Jan 2011
Posts: 26
Default ALIF Denied by Tricare, where to go from here....

My wife had a back injury in 1998 and it has progressively gotten worse. The last four years being the worst. She has been diagnosed with DDD in L5/S1.
She went through the pain clinic routine and injections with minimal to negative results.
She then had a spinal cord stimulator implanted for a year that even had an adjustment half way through when it wasn't working. It was finally removed this last year after it did nothing and actually caused pain in additional places in her back. (3 unnecessary surgeries)

We then were referred to a spinal surgeon who recommended an ADR, but as I am in the Marines, Tricare will not authorize it, so they submitted for an ALIF. Tricare came back and required a Discogram, so that was another painful procedure.

We went for the second opinion and the other surgeon confirmed the ADR is preferred, but the ALIF should be able to help some. Our primary surgeon seems a little overly positive that the ALIF will get her back to 100%. This has created a shadow of doubt that this is the way we should go.

We just received the denial letter from Tricare because they claim it will not resolve the problem.

Additionally, our current surgeon made a "mistake" on my wife's pain meds, so we are in a tough spot right now. We don't have a lot of confidence in our doctor, the insurance is shooting us down, and we are not sure who to turn to with regard to fighting insurance, finding the right doctor etc.

So, I will continue reading here and i hope this serves as an introduction, and any encouragement, crazy ideas etc, would be appreciated. Thanks for providing a good resource-John
Reply With Quote