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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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  #11  
Old 05-06-2016, 02:22 AM
JinSong JinSong is offline
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So sorry to hear this! I lost my appeals too, and I'm now the proud owner of a janky ACDF.



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33-year-old female
C3/4 Disc bulge and bone spurs
C4/5 Disc protrusion
C5/6 Disc extrusion with cord compression, bone spurs due to uncovertebral arthropathy, right foraminal stenosis and bilateral nerve compression.
C6/7 disc protrusion

Lost appeals for ADR. C5-6 ACDF on 3/10/16
ACDF never fused, and ACDF accelerated damage of the other levels. Someone please kill me.
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  #12  
Old 05-06-2016, 02:31 PM
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Romakis Romakis is offline
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Posts: 197
Default janky fusion

Makes me so angry that the system makes us chose not the best options... I hope you heal well...
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46yo, DDD of L4-S1. Microdiscectomy L5-L4 in 2014. L4-L5-S1 M6 ADR with Dr. Clavel - June 2015.
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  #13  
Old 05-07-2016, 03:55 AM
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scoop302 scoop302 is offline
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That sucks insurance won't pay, but they will pay for a procedure that has a high rate of adjacent level disease in the future. An ortho that I know said the policy may be due to the fact that in an ADR, the surgeon needs to clear out any bone spurs or deposits, etc. That way everything is nice and clean. In a ACDF, its not done as there is no more movement, so its an easier surgery and everybody makes more money.
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1979 car accident: rear ended
1980 ACDF C4-5
4/8/11 stopped, hit again
3 epidurals, PT, 2 MRI's,etc.
scheduled 3 times for C5-6, 6-7 fusion,
plus laminectomy at C3-4, and C 7, advised to do Bilateral lamino-foraminotomy C5-6, C6-7,a Percutaneous Discectomy L4 -L5
7/14 RFA on L3 to L5 (awake, local only)
C5-6,6-7 M-6 ADR with Dr. Clavel 9/17/14,
12/7/15 RFA L2-S1, Facet injections C2-7
6/3/16 RFA L2-S1, epidural L4,5, 8/26/16 RFA C1-7
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  #14  
Old 05-07-2016, 06:05 AM
JinSong JinSong is offline
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Join Date: Jan 2016
Posts: 57
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I'm actually currently freaking out about this. My surgeon said he cleared the nerve exits on both sides during my surgery, but post-op I still have horrible radiculopathy in my right arm. He said he thinks it's from cord compression.

Last week I finally got out of my cervical collar and got back driving privileges, then ended up with a bunch of weird new symptoms. Surgeon ordered me back into the c-collar and to go get a new MRI ASAP...three days after I called to report the new symptoms.

Got the MRI yesterday, and he was supposed to review it today and call me...but never did (trust me, I called the office five times to try and make it happen).

However I did get the radiologist's report, and this is what I find:

pre-op MRI report for that level: C5-6: There is a broad-based disc extrusion eccentric to the left, resulting in spinal stenosis with cord compression. There is a moderate right neural foraminal stenosis secondary to uncovertebral joint arthropathy.

Post-op report: C5-6 intervertebral postoperative changes of ACDF. The spinal canal is widely patent. Right-sided uncovertebral spurring results in mild to moderate right neural foraminal narrowing. The left neural foramen is patent.

Tell me if I'm reading this wrong, but it looks like he did NOT remove the bone spur on my right nerve canal at all!!! And I still have horrible right arm pain plus all these new post op issues from the stupid ACDF and what turns out to be an oversized PEEK cage (you can actually see how big it is in my images).

The nightmare never ends and I don't know what to do :'(
__________________
33-year-old female
C3/4 Disc bulge and bone spurs
C4/5 Disc protrusion
C5/6 Disc extrusion with cord compression, bone spurs due to uncovertebral arthropathy, right foraminal stenosis and bilateral nerve compression.
C6/7 disc protrusion

Lost appeals for ADR. C5-6 ACDF on 3/10/16
ACDF never fused, and ACDF accelerated damage of the other levels. Someone please kill me.
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  #15  
Old 06-30-2016, 11:46 PM
beaverc beaverc is offline
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Join Date: Jul 2010
Posts: 119
Default "psychiatrist"

Sorry to hear all the crap you are dealing with, sounds like some of the CA criminal work /comp system garbage I am going thru and have gone thru. People who do not understand and have never dealt with this type of trash can not even imagine it even exists. They would probably not believe this if they read it for themselves!! HANG IN THERE !!!!!!!!!!!!!!!!!!

"Dr. Peggy Ebinger, MD is a psychiatrist in Virginia Beach, Virginia."
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  #16  
Old 07-17-2016, 10:11 AM
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colorado babe colorado babe is offline
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Join Date: Aug 2014
Posts: 345
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Do another appeal and don't give up. I won on my third appeal.
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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  #17  
Old 07-18-2016, 10:01 AM
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Romakis Romakis is offline
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Default Anither Appeal

Quote:
Originally Posted by colorado babe View Post
Do another appeal and don't give up. I won on my third appeal.
Thanks, but what else could I possibly add to the paperwork? I already submitted over 50 pages. I have no idea what else to add to it...
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46yo, DDD of L4-S1. Microdiscectomy L5-L4 in 2014. L4-L5-S1 M6 ADR with Dr. Clavel - June 2015.
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  #18  
Old 07-25-2016, 08:51 AM
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colorado babe colorado babe is offline
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Join Date: Aug 2014
Posts: 345
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If I recall when I was dealing with denials, each time they gave me a different reason for denying. Make sure you're providing evidenced backed practices to refute the denial. Don't forget to include articles that show ADR is less costly and healing is faster thus saving insurance thousands of dollars in the long run. I also contacted my congressman who helped me tremendously since my insurance is Tricare and my injuries were all service connected.
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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