Another WC denial for surgery (hybrid)

[Mariaa]

This time the hybrid surgery with ADR at L4 (charite) and fusion at L5S1 has been denied (non certified) and there was a 7 page attachment with it reasons it was denied.

It's gotten to the point of being a ridiculous matter because much of the denial was based around the fusion if you can believe it as in I'm not a candiate for fusion because I don't have instability.. and then of course the ADR was denied because it's just been recently FDA approved and there's not enough data to support it's use in my case in terms of being reasonable and necessary treatment (same was said for fusion).

So I am going to cash out with WC and take my business elsewhere.. finally.

I guess this is what they are aiming for, I just hope I get a fair settlement because this denial makes it sound like I'm not a candidate for anymore spine surgery based on my failed 2nd discectomy...

Wow, what a pain in the rear. Perhaps a sign, message, and so forth..

[Eddie_G]

That really sux!

Any chance you can link us to those reports? I'd love to see how they shovel their bulls*&t and then maybe we can reverse engineer their processes.

I know they don't accept the European studies and that's definitely a problem...

[sahuaro]

Maria:
I am so very saddened. You have been through so much in this process. But, the silver lining is that it forces you (or frees you up) to make your own decisions. Wishing you much luck in the settlement.
Barbara

[spotty14]

Nothing they do makes any sense and mean while you wait and wait. I'm sorry to hear that you were denied again after all the tests and evaluations you went through. Delayed treatment is denied treatment. I hope you can cash out and be able to head off to Germany and get the surgery you need.

[Mariaa]

Now I see why the law firm I used way back when had said they hadn't seen the older cases come away with much than $30k settlements. If one's made to sound like even tho multiple surgeons propose surgery, that it's not deemed necessary or reasonable, then there's no surgery to make a settlement on~ rather just some ongoing treatment for a few ESIs/year and cheap meds...

BTW, I had to wait 6 months for an ESI this past year...that's the longest interval I've gone in the last 5 years I've been receiving them and it was torture waiting that length of time. By month 6 I was ready to have surgery with a couple of kids playing doctor and nurse...

[Mariaa]

Update to anyone following~
WC Utilization Review sent me so many letters of denial for this last procedure. Anyway, next step is for surgeon to Appeal, then I'll be sent to a QME and the decision will be rendered there. Work Comp is looking to settle one way or the other, and the only thing that's going to happen is settle without surgery on the table (less money) or settle with surgery on the table( more money)..