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Old 04-11-2014, 10:22 AM
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Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
Posts: 259
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Jerry,

Hang in there! It's frustrating, I know. I have dealt with insurance companies for 15 years with my massage business. In the last two years or so we have been receiving a crazy high number of denials for very stupid reasons for massage treatment. This is not an expensive treatment in the insurance business, yet they don't even want to pay for that these days, let alone an expensive surgery.

What I have learned is they bank on those people who won't try to fight it, those who don't know they can, or those who are in too much pain to wait it out. Fortunately, I am not in any of those situations.

For me, it would be different if the denial was for a valid reason. If they deny due to "experimental/investigational" and it actually was, I could trust that they don't want to pay for treatment that might harm people. But, when they use this blanket statement as a first level automatic rebound, full well knowing there is plenty of proof otherwise, it makes me mad. not to mention the fact that my spine clinic has had this exact same surgery paid by my insurance four times before? I'm willing to jump through hoops just for the principle of it all.

I would recommend picking a day of the week to deal with insurance issues, whether it be appeal prep, phone calls, research, etc. make sure you check with insurance once a week if you are waiting on something, otherwise you could wait a month to call them and hear the infamous "we never got it". Then, the rest of the week, live your life. Take care of yourself and remember to do small things to help your pain, etc. it is so easy to fall into the trap of focusing so much time and energy on being mad at insurance and waiting for surgery to cure you, that we forget to live our life. I had to consciously decide not to let this consume me.

You said you saw a VA MD? What branch of the service/era were you in? Have you tried any other VA resources to help you with the process? My dad and husband are both Marines, veterans of Vietnam (dad) and Gulf War (husband). The VA has come a long way providing resources to veterans, so much so that my dad is seeking services that he swore he never would because they have actually been helpful.
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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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