Yes, these guys will do anything to avoid paying. I am always leary when I get a phone call looking for information from my insurance company.
about 10 years ago when my back pain started I had a team of doctors saying the a breast reduction would drastically help my back pain. Back then I was 44DD, and had DJD and DDD, but had my family doctor, PM, orthopedic, chiropractor and reconstructive surgeon all say this should help me avoid rapid progression of by back pain. My surgery was denied, as was 2 levels of appeals and a final appeal thru my employer. All reviewed by a nurse case manager, initially till the final review board. None of my drs could believe I was denied.
10 years later I am suffering, who knows if a reduction back then would have prevented most of what has happened. If I think about it, it only makes me angry.
Not sure what recourse you have now kat. What are they saying about the fact that someone precerted the procedures? It was pre-approved based on their guidelines, right? As you said a doctor will not just put them in without checking this first. Just a question that came to my mind, was this precerted by the first insurance company and done under the second company? That would make a difference. That is the only thing that I can think of, but I still am not clear on your time line.
I guess everyone should take this as a lesson to make sure EVERYTHING is documented in black and white in your medical record. Every complaint, fall, injury you sustain due to your pain, events you miss due to uncontrolled pain, work accomodations, medication side effects, things such as meditation, relaxation, yoga, etc........
I wish you luck with your appeals Kat!
DX: CRPS, Fibro, CP, DDD, DJD, OSA, Syringomyelia, Arachnoiditis, failed fusion. Fusions C5-6, L5-S1, hardware removal and removal of scar tissue. SCS trial successful awaiting placement.
MEDS:To many to mention, changes every week it seems.