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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #21  
Old 03-25-2006, 12:41 AM
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Eddie_G Eddie_G is offline
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I see that now. Good luck. I'll let you know what Liberty Mutual says so maybe you can reference some of their findings for your case.
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12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #22  
Old 03-26-2006, 02:05 PM
luvmysibe luvmysibe is offline
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The process certainly can be trying and the extended timelines benefit the insurers. Stay vigilant and continue to make phone calls and ask questions. In the meantime, massage and lymphatic drainage may help reduce some of your unpleasant side effects.
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  #23  
Old 04-24-2006, 05:06 PM
go*big*red go*big*red is offline
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First of all, LBP - Colorado Insurance Division has jurisdiction over this because we purchased the policy in Colorado, from a Colorado agent and we are located in Colorado. I have, since I first posted this, got Colorado Insurance Commissioner involved. They have been very gracious and have tried to contact PC 4-5 separate times by phone giving them ample time to answer some questions over the phone with no response! So, as of today they are lodging a formal complaint with an inquiry. I'll have a copy of the letter by the end of the week.

I think that #1, PC always says to contact State of California because that's where they are based and are banking on people not inquiring further with their own Division of Insurance. #2, That they (we) will get tired and just plain give up. (I gotta tell you I was almost there!)

If you purchased your policy in CA, then maybe that's why it stayed there?

Also, Crystal - I am doing massage therapy - have for gosh, about 6 years. I don't think I'd be standing if I didn't have that. Just had my bi-weekly massage this morning.

I've been in so much pain, the nerve block has worn off for the most part - I've got a call into my surgeon to see if we couldn't go ahead and schedule the surgery for the 2nd week in July as my policy is up for renewal in August and I would have to meet my $3K deductible again. That's the other thing I think they are counting on and that is getting into a new policy period. This way, if I am approved, I'm on the schedule. If I'm not (I'm not even going to go there!) then we can cancel. Don't know if they're willing to do this, but I'm gonna ask anyway!

*sigh* - all this red tape!
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Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #24  
Old 04-24-2006, 05:50 PM
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For you UHC guys, I talked to the insurance Manager at my doctor's and she said that she has gotten UHC to pay for ADR recently. As long as the policy is based somewhere other than NYC then you have a chance. I'll ask her about it the next time we talk. Keep chugging along big red!
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  #25  
Old 04-24-2006, 06:02 PM
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texas-t why is nyc singled out any idea.
im scatching my head on that one.
chuck
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  #26  
Old 04-24-2006, 06:25 PM
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I have no idea, but will ask. I suspect that UHC NY is a seperate business entity in some form.... but it makes no sense that one part of a company would pay for ADR while the other arm does not. The more I learn about insurance the more upset I get.... it's crazy.

Does the state have any effect on policy coverage? I think I read somewhere else on the board of individuals having issues with insurance based in NY.... just a thought
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  #27  
Old 05-13-2006, 07:18 AM
go*big*red go*big*red is offline
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Well, if you will note, my name has changed as I couldn't get logged in under my old name. So, no astricks.

ANYWAY - just to update everyone, finally got the Independent Medical Review request off to TX, not CA (TX is just where they process) and now CO is handling my case. PC or UHC or whoever the heck is making the decision on the REST of my life has 30 days to respond on decision. They must have received it sometime last week I'd say Thurs or Fri. So, 1 week down, 3 to go.

In the meantime, I've packed on weight, been depressed and in more pain and now both legs hurt, not just one. I'm going to have bariatric surgery prior to my ADR if they wait much longer! Nothing to kid about, I know and I'm not kidding.

Well, huh! Look at that, my astricks are back, but I've only posted 3??? Oh, well, no biggie. At least I'm back
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Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #28  
Old 05-22-2006, 04:42 PM
go*big*red go*big*red is offline
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Okay - so an update.... I received a letter from Pacificare today stating the date and time of my phone interview - Wed, June 7 at 1:00 MST.

Has anyone here done this before with their health insurance company? This interview? What am I to expect. I want my surgeon (my designated representative) to be with me on the phone with them. They said in the letter that I could have him there.

I'm a bit nervous. This is it. Again, what am I to expect? Are they going to rake me over the coals? What???

I'm now dealing with occassional bowel incontinence. Sorry, but it's a fact. I imagine that it is just part of it, right? The whole thing just sucks if you ask me!
__________________
Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #29  
Old 05-22-2006, 06:12 PM
sahuaro sahuaro is offline
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Good luck on your phone interview! Two thoughts: tape the conversation (I'm sure your insurance company will be taping it as well) and be sure to get the name and credentials of the person on the other end. Is this really suppposed to be an "independent medical review?"--IME's are a farce anyway but medical exam by telephone?! As a provider, it is usually not a good sign when an insurance company asks me to do a phone review--they're usually going through the motions before they deny benefits. I hope this is different for you.
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2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #30  
Old 05-22-2006, 07:00 PM
go*big*red go*big*red is offline
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Me, too. But, I do have the opportunity to do it in person, but I'd have to fly to Texas and I'm sure my surgeon wouldn't do that. And, I don't want to do this alone!

Thank you!
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Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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