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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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Old 10-17-2011, 07:44 PM
Shay Shay is offline
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Default Educating docs along the way

After telling my GP about consulting with surgeons out of the country since we lost the appeals for fusion with Regence, she got on the horn with the MRI doc.
Since previous MRI reports didn't mention the magic word- spondylosthesis that is required for fusion coverage, nor did the surgeon, she asked this MRI doc if this was so. He tells her that, "Yes, Shay has spondylosthesis, I didn't know they wanted me to use that word." AHHHHH!

So now he is writing an amendment to the MRI, sending it to the surgeon, also trying to talk to the surgeon as to why he didn't see it himself.
This is craziness.

Months of pain, and stress and appeal work, all because the report was written up incorrectly.

Anyway, I'm trying to see this as an opportunity to get clearer on my diagnosis, before rushing into the planned fusion. This is a red flag for me with the original surgeon. I plan on asking him about it.

Meanwhile I have consultation pending with 4 other surgeons to get clarity.

Just a reminder to pay attention to EVERYTHING! This only happened because my partner Yona came to the appointment with me and pestered the doc.
On a Butrans patch today, feeling less pain and kinda high.

Shay
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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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Old 10-17-2011, 09:15 PM
annapurna annapurna is offline
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I mentioned this years ago but it's worth retelling the story given your lead-in. Six years ago Laura was working with a radiologist, the only radiologist in Utah that we were actually able to speak to ourselves. He understood Laura had an artificial disk at L5S1 and what that meant to her spinal mechanics and had adjusted the MRI parameters to "throw" the metal artifact away from her facets at that level. While he was reading the MRI, composing his report, and explaining things to us, he casually mentioned that most radiologists wouldn't read or report facet joint condition. He pointed our that, with fusion as the only option, radiologists "knew" that facet joint condition wouldn't be the deciding factor for treatment and they didn't bother trying to look. He was willing to acknowledge that the whole situation shifted with use of ADRs but told us not to expect that look from anyone else in his profession unless significant education efforts were made ahead of time.

On top of that, another doctor just told us about the very high likelihood of the radiologist reports in this area being dry-labbed, but that's due to another problem, unrelated to education and experience.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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Old 10-19-2011, 09:30 AM
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Harrison Harrison is offline
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This is very good news -- better to find this out now -- than later! Yona, good job. Please clone yourself and we'll issue a YonaClone to every patient who needs an appointment companion.

Jim, can you talk a little bit more about this notion of "dry-labbing?"
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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Old 10-19-2011, 07:38 PM
annapurna annapurna is offline
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There's not much I can say other than (doctor's office who shall remain unnamed) accused many of the radiologists in the greater Salt Lake City of writing MRI and x-ray reports around the description of symptoms and age of the patient instead of actually reading the images. One report stated that my wife was bone on bone when a simple perusal of the films showed that she wasn't and, when we spoke with the unnamed doctor, he said that kind of behavior was more common than we would have wished.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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Old 10-24-2011, 03:59 PM
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laid up doc laid up doc is offline
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i have found that good pain docs and surgeons ALWAYS look at their own images... and usually comment on much more than radiologists.

there are countless stories of missed calls by radiologists... head bleeds, collapsed lungs, fractures, you name it.

radiologists also have their own normal "macro"... if what you're needing to have looked at isn't in their macro, it may or may not be normal.
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US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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