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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #1  
Old 07-30-2006, 11:33 AM
Mariaa Mariaa is offline
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This time the hybrid surgery with ADR at L4 (charite) and fusion at L5S1 has been denied (non certified) and there was a 7 page attachment with it reasons it was denied.

It's gotten to the point of being a ridiculous matter because much of the denial was based around the fusion if you can believe it as in I'm not a candiate for fusion because I don't have instability.. and then of course the ADR was denied because it's just been recently FDA approved and there's not enough data to support it's use in my case in terms of being reasonable and necessary treatment (same was said for fusion).

So I am going to cash out with WC and take my business elsewhere.. finally.

I guess this is what they are aiming for, I just hope I get a fair settlement because this denial makes it sound like I'm not a candidate for anymore spine surgery based on my failed 2nd discectomy...

Wow, what a pain in the rear. Perhaps a sign, message, and so forth..
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  #2  
Old 07-30-2006, 12:49 PM
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Eddie_G Eddie_G is offline
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That really sux!

Any chance you can link us to those reports? I'd love to see how they shovel their bulls*&t and then maybe we can reverse engineer their processes.

I know they don't accept the European studies and that's definitely a problem...
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12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #3  
Old 07-30-2006, 02:25 PM
sahuaro sahuaro is offline
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Maria:
I am so very saddened. You have been through so much in this process. But, the silver lining is that it forces you (or frees you up) to make your own decisions. Wishing you much luck in the settlement.
Barbara
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2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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Old 07-30-2006, 11:34 PM
spotty14 spotty14 is offline
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Nothing they do makes any sense and mean while you wait and wait. I'm sorry to hear that you were denied again after all the tests and evaluations you went through. Delayed treatment is denied treatment. I hope you can cash out and be able to head off to Germany and get the surgery you need.
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7/05 EMG/Nerve Conduction Tests
8/04 Disqualified from ADR clinical trial due to severe osteoporosis -- getting treatment
3/04 updated MRI
11/2000 IDET L 3/4, L4/5
1/2000 Discogram
numerous epidural injections
physical therapy
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  #5  
Old 07-31-2006, 02:11 AM
Mariaa Mariaa is offline
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Now I see why the law firm I used way back when had said they hadn't seen the older cases come away with much than $30k settlements. If one's made to sound like even tho multiple surgeons propose surgery, that it's not deemed necessary or reasonable, then there's no surgery to make a settlement on~ rather just some ongoing treatment for a few ESIs/year and cheap meds...

BTW, I had to wait 6 months for an ESI this past year...that's the longest interval I've gone in the last 5 years I've been receiving them and it was torture waiting that length of time. By month 6 I was ready to have surgery with a couple of kids playing doctor and nurse...
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  #6  
Old 08-03-2006, 09:05 AM
Mariaa Mariaa is offline
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Update to anyone following~
WC Utilization Review sent me so many letters of denial for this last procedure. Anyway, next step is for surgeon to Appeal, then I'll be sent to a QME and the decision will be rendered there. Work Comp is looking to settle one way or the other, and the only thing that's going to happen is settle without surgery on the table (less money) or settle with surgery on the table( more money)..
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