Need lot's of help

curly4552 · #1 02-11-2009, 08:22 PM

Hi,
I tried to get the info from the freedom of info act about oxford or UHC. It might not be available or take a long time said the NY ins. board .I most likely wont get it in time for my appeal. If any one has info I could sure use it.

About me: fell down stairs landed on right side. Feb, 2006 Had rotator cuff (successful) repair Dec. 2006 after 6 mos of PT and 2 cortisone shots. The recovery was worse than giving birth!!! I was in so much pain I took 20 percoset in 2 hours. I have a bad time with pain meds. I am now allergic to percoset and vicodin, horrible itching. I can't take Nsaids any more it killed my stomach. I have a TENS unit . I see a pain mgmt specialist at NYU . He looked at my cervical spine tried to treat it and then sent me to see a surgeon.

I really am afraid of another surgery. I have seen 5 spinal surgeons and have had 3 MRIs a cat scan Myleogram ( had a leak and needed a blood patch) I was on fentanyl 25 patch for 8 months while I had 3 epidurals, a foriminal injection. 3 EMG studies I had a really horrible time going off the fentanyl I did it so I could see how much pain I really have. I have DDD at C5 6 7 Impingement at C5 6. Surgery would be at C5 6. I mostly have burning pain down rt arm, drop things constantly and pain at my right shoulder blade.

Some Md's said They don't think surgery would help. The ones at NYU/JD think it will 75% chance. Dr. Bendo and that team does the trials for prodisc C. He said truthfully it would be my decision to proceed and which surgery to do. I am very scared and want the easiest recover and the best outcome. I am in more pain again but not as bad as anyone else. Mostly a 2 sometimes a 5-6 with a lot of activity. Lots more to say but here is a start.

I need advice!!! Thanks, Julie

Harrison · #2 02-12-2009, 01:01 PM

Julie, welcome! I'll chime back in later, but thanks for finding us...

curly4552 · #3 02-12-2009, 02:48 PM

I am new and I am fighting Oxford UHC for adr. I am really nervous about any more surgery. Doc says 1 day surgery or maybe overnight. Is the recovery the same or better than a fusion?? I am not sure I even need surgery on some days, when my pain is minimal. Other days I think I should do it cause I have real pain and I am out of other options. I am also scared of sore throats(weird). I have had many cases of tonsilitis and strep. I have pain management issues. Is it worth it? Will it help with my rt arm ridiculopathy . What is the worst case scenario?? Doc said he has had no real problems.
Dr. John Bendo NYU/JD ADVICE PLEASE

rhatzy · #4 02-12-2009, 10:55 PM

John,

I know a lady who had a one level cervical M6 ADR. A couple of months later, she rode her bike from Alabama to Ontario and then she rode from Vancouver to San Francisco. She is totally pain free and normal. However, It all depends on what you go in with. Do you have facet problems, arthritis or anything else? Are you sure it is your disc causing your pain? These are things you need to answer. Surgery is surgery. They all have the same risk in the end, so you have to weigh your risks and rewards.

Mark

curly4552 · #5 02-12-2009, 11:24 PM

Hi,
It really is unclear what I have. I have herniated discs at C5-6 and 6-7
C5-6 is pressing on the thecal sac . Some doc's say they are not sure if surgery will help. It seems to be a straight forward procedure no other problems show up. Everything else looks good. I am at the end of my rope.. Nothing seems to help except when I was addicted to fentanyl patches They are great for pain actually amazing, with it I had no pain, but could not be with out the fentanyl . When I decided not to live my life as a junkie withdrawl was horrible and the pain was still there.

Jessica · #6 02-13-2009, 01:15 AM

My advice - I would not have surgery without a discogram first. My MRI showed no bulge on C6/C7, yet it turns out that C6/7 is torn and was/still is causing more of my radicular pain than the C5/6 that was impinging the spinal cord. I should have had a double. It took 2 years to find out that I should have had a double level. A good discogram will prove where the problem comes from. My recovery was a breeze. I, too, have always had lots of strep and gland infections, sore throats, etc. No problem for me in that area.

Best of luck to you. Feel free to ask any questions.

curly4552 · #7 02-13-2009, 11:16 AM

Thanks so much for your input. I can't find an md. who does cervical discograms, in network. I will try again you are right. This is NYC and I can't find one. I did have a myleogram which looked prretty much the same. I am still trying to get help in fighting Oxford Or UHC for approval on 2nd appeal and state appeal. my friends who have had fusions are happy, but the word cadaver bone freaks me out. I also think ADR has a better chance of success.

Thanks Julie

Harrison · #8 02-14-2009, 02:22 PM

Hi Julie,

Have you seen the topics on UHC in the Insurance Hell forum? There’s a good one today from Kimmers.

Also, please take a careful read through this topic on ADR qualifications: ADR Risks, Complications, Disqualifications

And if you really want to add insult to injury, check out how much the CEO of UHC made last week…at least on paper…$95,000,000. I saw it in the WSJ but can’t find it online….

curly4552 · #9 02-15-2009, 10:48 AM

Hi Harrison,

Is there any way to actually get the information on the cases that were approved??? It would be the thing I need to try and fight Oxford. I will not be getting the information any other way. Does anyone actually have it??
Thanks, Julie