Spine Disease: Strategies for Receiving The Best Treatment.

[biffnoble]

How does the patient get their insurance co. to authorize surgery in the case of debilitating (e.g. poor quality of life and inability to be gainfully employed) cervical neck pathology when the complaint is pain with clear MRI evidence of significant cervical pathology, but minimal neurological deficits?

If the necessity of medical treatment, and the insurance co. indicates willingness to pay for treatment is established how does the patient get the best treatment available approved? E.g.: all of the alternatives to �traditional� surgeries like: MISS, ADR, etc.?

Any solutions, strategies, ideas?

[annapurna]

An excellent question. I think that lots of it starts with having the luck of having a good insurance policy that covers the type of treatment you need. In my case, it doesn't matter how many artificial discs are approved in the US, no one in my local area does them, so, my insurance (which is a local-area HMO network only) will not cover it - end of story. If you are lucky enough to have a good policy, then I would work with your treatment provider(s) to write up a good description of your pain-disability-lack of function. If you can't work, due to cervical pathology, then you're functionally disabled. It is then in the interest of both employers and government to get you back to work (whatever your work) rather than have you collect disability. This will put some pressure on insurance companies to do SOMETHING. The problem then becomes, will they do the optimal something and pay for the treatment you really need. There have been some excellent posts about insurance appeals and presentations that were successful (people got paid). I think that one key is serious persistence in making appeals and such.

Best of Luck!
Laura