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Old 11-02-2011, 02:46 PM
Shay Shay is offline
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Join Date: Aug 2011
Posts: 59
Default I know your frustration!

It's all very sick, our health care system.
It was only throughout the appeal process did we come to understand who writes the medical policies and how inadequate they are for the job.
I am happy to see increased awareness in WA state from surgeons of the real issue at hand and hoping this awareness will spread regardless of what I end up choosing to do for my spine.
In fact, during our final 4th appeal with Association of Wa Cities, since we don't expect that our denial will be overturned we will use this a platform to share this new study and the issues it brings to light.
my doc had this to say in his email last night....

"Unilateral change by the payers is detrimental to our patient care.
I am bothered payers can make such dramatic moves without having to reopen our contracts.

It is under the guise of quality.
The correct way toward this goal would be to sit in the room with leaders in
Spine Care, recognize that UW Medicine is committed to the best in care, and
determine a go forward that does not put in place hard stops but rather
helps converge on what is appropriate and what is not."

I'm considering posting his letter that speaks to this directly. I guess if he CC'd regence then it is fairly public, right? Anyway he sums up the situation pretty well in the letter.
Baby steps, right?
__________________
Diagnosed with bulging disc in L5/S1 in the 90's.
Tried every non-surgical technique over the last 8 years .
2009decided upon Prodisc.
2010 scheduled ADR surgery, denied, scheduled fusion, denied also.
2011 Appealed fusion all the way up. Lost.
Current MRI: moderate foramina stenosis and .collapsed disc in L5/S1. Spurs and fusion of disc also.
L4/L5 small bulge and slight stenosis.
1/18/12 I became Borg. double ADR w/ Mr. Boeree
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