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Old 08-26-2006, 11:02 AM
Mariaa Mariaa is offline
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State of California Work Comp Board had sent me to a 2nd surgical opinion for an exam because I had 6 UR non certifications/denials for surgery.

This Neurosurgeon 2nd surgical opinion was to either agree or disagree w/my doctor's request for hybrid (ADR at L4 and fusion at L5S1) request. If he denied the surgery, he was to make recommendations for ongoing care (conservative w/o surgery) and I would be settled out in terms of my future medical benefits with a minimal monetary amount that would not cover surgery now or in the future.

I cannot drive any distance so WC was to provide transportation for nearly 2 hour trip to my designated appointment and back.

I decided to ask Mark ******* to accompany me to this appt as a Patient Advocate since his knowledge and experience working with world renowned spine surgeons and familiarity with my case could make a significant contribution I hoped. Even more importantly, this Neurosurgeon's decision could make or break my case at this point.

The first snag was that even tho we left LA county in a timely fashion, the traffic was bumper to bumper so I put in a call to the office to notifiy them I may be a few minutes late.

Upon reaching the office I was told that the doctor had been called away on an emergency so could I reschedule at 5:30p.m. (from a 2pm.) appt. I looked at Mark as he was driving, relayed the info and he said "take the appt." so I did.

The appointment was at Scripps La Jolla with a La Jolla Neurosurgical Group surgeon. There was only one other patient before me who was a recheck on an emergency fusion at L5S1. He was 6 weeks post op with a brace and doing great. He thought this surgeon had done a wonderful job on his spine.

So I'm waiting and getting more and more nervous, Mark was really good to keep me focused/collected and not turn into a weepy emotional wreck (I was on the verge every second).

When I got called into the exam room, Mark came with me and the Neuro introduced himself stating that this was a 2nd Surgical Opinion and I felt he was kind of guarded with his opening statement as a WC appointed doctor would be.

He asked how my back felt and the subjective part of the assessment was very open so I stated how my back hurt, what made it hurt, what my average day was like and so forth.

I think he left this part open to see if I would exaggerate symptoms or state things that wouldn't coincide with clinical findings.

While giving the history, I left out some pertinent information which Mark was quick to interject. I'm so glad he was there as I would have just forgotten to state this information.

My Neurological exam was very comprehensive. After this the doctor stated he was going to take the films into his office and review them.

At this point Mark asked if he could accompany him and review the films with him. Great save as the doctor said "sure" and then "we can review them right here in the room."

At this point it was like two collegues standing there reviewing my films, extracting salient points, noting subtle and not so subtle changes and what this meant in terms of my spine.

I felt having Mark present made a huge difference here, otherwise without him even had I requested to go over films with the doctor and he agreed, much of the information would have gone right over my head/by me since I was just too tired and in too much pain.

At the end of their review of my films and their discussion of my case, the Neurosurgeon said he thought the hybrid surgery proposal was a valid one for my case. He said he would write a report to that effect, and Mark was right on it telling him how much this decision would mean to my case as I was on my last leg and being booted out with all the denials.

Their was a meeting of minds there as Mark and the surgeon for all the obvious reasons based on assessment and clinical findings agreed that I was a candidate for this type of surgery because of my findings even tho I had been denied this surgical request multiple times by WC Utilization Review doctors.

While I think this Neurosurgeon is the kind of person that would have rendered this decision most likely, I am certain that Mark *******'s presence as a Patient Advocate made an incredible difference with how my case was handled at this appointment.

I have to say that I wish I had taken him with me to all my surgical opinion appointments and that if I have to go to court, I'm most definately going to ask Mark to accompany me as a Patient Advocate as his knowledge and experience would allow him to go toe to toe with anyone disputing my case and I think give rise for an Administrative Judge to rule in my favor dispite the current guidelines that WC utilizes to deny such cases as my own.

I hope that this post won't be deleted or disputed in terms of what I have written regarding my utilization of Mark's patient advocacy skills.. he's an awesome advocate~ and WC is a terrible foe when they desire to be so!

I await the report to make sure I have reason to celebrate and also wait for the next WC shoe to drop!
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Old 08-26-2006, 11:33 AM
chasswen chasswen is offline
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well thats great news
looks like you may be on your way to getting your life back. i surly hope this is the end of this endless mess that has been trailing you for ages now.
may the force be with you
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #3  
Old 08-28-2006, 09:26 AM
Mariaa Mariaa is offline
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Thanks for your reply Chuck, I'm really happy about the outcome of the appt. and still awaiting the next hurdle to go thru w/WC..always something or so it seems.

My back is killing me right now. Thought it was OK on Sat. and had a pretty normal day tho yesterday began with big time pain so guess it was kind of a delayed response to a full day of bouncing around on Friday..

Hope your distraction pain is easing up!
take care and thanks! Maria
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