Insurance Game

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Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 11/9/2007 3:24 PM (GMT -7)   
My Doctor wants me to have a discectomy and it explained it to me. Insurance has still not approved of it. The Doctor sent it in to my insurance company back in early September and his office called them two weeks ago and they said it could be another 60 to 90 days. This procedure could help my back pain and insurance is dragging its feet!! Why!!! If insurance does not approve of this procedure this year, can I sue them next year for the deductables and co-pays? What would y'all do? Anyone else been thru this?
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* Asthma
* Allergies
* Osteoarthritis
* Spinal Stenosis
* Mild DDD
* Enlarged
Pituitary Gland
* Fibromyalgia
*************************

Patient: "I always see spots with my eyes"
Doctor: "Didn't the new glasses help?"
Patient "Yes, now I see the spots clearer"


TexasJen
Veteran Member


Date Joined Dec 2006
Total Posts : 649
   Posted 11/10/2007 9:31 AM (GMT -7)   
If your insurance is a group policy through an employer, start with the Benefits Coordinator.  That person should be able to help you get an approval sooner.  Don't just take some idiot at the insurance company's word for the final answer.  You'll have to work your way up the food chain to get the right person.  That's where the Benefits Coordinator should help - with the name of a patient advocate to help get this through.

Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but living with my wonderful husband, 2 dogs, 1 cockatiel, and 2 gold fish. 


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 11/11/2007 2:49 PM (GMT -7)   
Thank you TexasJen, we'll be talking to the HR Rep on Monday. Lets hope they can get this thru the insurance company faster. Hope you doing better TexasJen and soft hugz to you and everyone.
************************
* Asthma
* Allergies
* Osteoarthritis
* Spinal Stenosis
* Mild DDD
* Enlarged
Pituitary Gland
* Fibromyalgia
*************************

Patient: "I always see spots with my eyes"
Doctor: "Didn't the new glasses help?"
Patient "Yes, now I see the spots clearer"


abc123
Regular Member


Date Joined Feb 2007
Total Posts : 172
   Posted 11/13/2007 9:17 PM (GMT -7)   
Look in to having a discogram, which can be a precursor to neurosurgery. It involves being partially sedated and having a radiographic dye injected and your reaction to pain monitored. Not all docs think it is an effective diagnostic tool, but it may fulfill your insurance's requirements. It is an outpatient procedure and far less traumatic than some sites portray (at least when I had mine in 2002). If a nerve is irritated during the procedure, the pain lasts for 30 seconds at the most and is a good indicator that a discectomy may be in order.

Stephanie
Stephanie

Dx: FMS/CMP/DDD - 2 ACFs with more to follow, scoliosis, mis-aligned pelvis
Rx: Cymbalta, Flexeril, EC Naprosyn, Ambien CR, Vicodin 5/500, Kadian 60, Buspar, Xanax, Seravent, Albuterol, herbal supplements and vitamins, Lidocaine injections, and Botox injections


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 11/14/2007 5:09 PM (GMT -7)   
Sorry Stephanie, I have had too many drs say it is a useless tool. In fact, some has said if the disc is not herniated before, it sure will be after a discogram. MRI or myleogram much better per these guys. Susie


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 11/14/2007 5:13 PM (GMT -7)   
Chart that is way too long to have to wait for an answer. If this is an insurance thru an employer, you yourself can call and find out what the problem is. If push comes to shove you can always contact the State Board of Insurance for your state. Ins Companies do not like having these folks breathing down their backs. Susie

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