Another Non Certification/Denial by CA UR

[Mariaa]

This time by an ER physician. Almost the same number of pages~ 4 this time vs. 5. Same content tho in terms of non certification/denial...

I didn't expect to get authorization however didn't expect to get more than one non certification and I don't see why an ER doc has the credibility to give a non cert.

Bah humbug .. this non cert is still for the 2 level ADR that the ortho in San Diego was behind. I've not even gotten to the non certs I'm bound to get for my recent visit to The Spine Center in Santa Monica with Dr.Bae...

[ans]

Sorry to hear this. Makes as much sense as a UR proctologist who denied an ENT test for me.

[Mariaa]

Now there's a specialty I'm bound to see hand down the next non cert.. Proctologist~

[spotty14]

I'm sorry to hear and that the insurance company will go to this extent to deny authorization for treatment that is obviusly necessary. Was this a separate opinion from your latest surgeon app't? By the time these non certifications are done the cost of them could have paid for your surgery already. What can you do to fight these?

[Mariaa]

Spotty,
This non cert was for a proposed two level ADR that really the surgeon in San Diego just thought was what I could have and referred me back to The Spine Center in Santa Monica. This should not have even gone thru as request for authorization but as you stated, the State wants to waste it's $ with going thru UR for everything.. (what a true waste of $)..

Re the process, I can appeal when there is something to actually appeal. I think it will be the authorization that has just gone in recently for Dr.Bae to do a "hybrid" surgery with fusion at L5S1 and ADR at L4.

As far as I'm concerned, I still need another discogram to make sure L3 isn't causing a prob but everyone looks at it on MRI and/or CT scan and says "it looks good".. then says even tho there is a bulge there and anular tear has been documented since the ice age...(it worries Me)

I'm no expert and certainly don't claim to be tho would rather really be as certain as possible that L3 doesn't also need intervention, because I think it'd be best to go in all in one shot and take care of business (if necessary).

Oh well, the discogram was denied already by UR a few months ago...

[spotty14]

Mariaa,
I understand now. They would have to agree to pay for another discogram right before your surgery. Wouldn't it just be part of the approval for ADR surgery. I hope this all works out sooner than later. Let us know.

[ans]

M: Maybe in one shot. I don't know when but at L-3, they're going to start (or have) a lateral vs. anterior approach acc'd to Regan.

Be well, ans

[LMay4111]

If you will contact me privately I may be able to assist you with getting approval with using a dr I know personnally and professioannly to do so contact me at LMay4111@aol.com thanks Linda