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Don't know what to think of my Dr. appt. yesterday...

DIFerrisDDIFerris Posts: 86
edited 06/11/2012 - 8:33 AM in Back Surgery and Neck Surgery
I was originally scheduled for L4/5 fusion on 7/2. The insurance denied the surgery saying there was not enough documentation sent in. Okay.

I had an appointment with the NS yesterday to discuss what needs to be done to provide more documentation. Lord knows I have documentation for tests, PT and different medications going back to 2005!

NS scheduled me for a discogram on 7/20, for L3/4, L4/5 and L5/S1. I can understand having the test done, as I am one of those people that is in a lot of pain but other tests are coming back negative. What I don't understand is the NS saying the results of this test will show them which vertebrae need to be fused. What about the surgery that was scheduled before the insurance denied me? What if the insurance had approved it and they fused L4/5 as planned and it turned out to be the wrong ones? I don't know what to think of this. The only thing I can think of is he meant that the results will show that the vertebrae do need to be fused due to the disc being the source of the pain and maybe he just didn't phrase it correctly? I hope so! I am confused now.

I am more than a little tired of not being able to do much other than sit on the couch or lay down and "rest". I am so tired of "resting" I could scream!

He gave me a prescription for Lyrica, which I will get filled this evening. I told him percocet did nothing for the pain I am in, and I do not want to take any narcotic unless it is absolutely necessary and it also needs to help the pain!

I am hoping this test, while painful from what I hear, will provide the results that the insurance company is looking for. I can't imagine what I will do if it is denied again. I am very worried right now. I don't know what I will do if the final answer in this ordeal is that I have to live with this pain and nothing can be done. I am in so much more pain than I ever was before my first surgery last year. I could just cry (and I have, but am trying not to now) :''( . I try to stay positive, but it gets harder as days turn into weeks which is turning into months.

I am also running out of time that my job is protected under the FMLA act. I have until 7/27 (that will be the end of 12 weeks that I have been on short term disability), then I can lose my job, and so my insurance, after that. I can, of course, continue receiving my health insurance coverage under COBRA, and have already been approved for long term disability, but BC is extremely expensive when it comes out of pocket! Oh my...

I'm sorry to go on and on... I guess lately I find myself venting more and more. Please, don't mind me!

Thanks for listening (or reading, as the case may be :))

I hope everyone is doing good today! It is at least a gorgeous day today in NY! Maybe going out and cutting some flowers will improve my mood :) It usually does.



  • You are having happening exactly what I had to do. I was scheduoed for 1 level fusion and had to have discogram to prove to insurance. It is a good thing because it showed I needed two discs done and maybe a third down the road. The test isnt that bad, they mildly sedate you, you have to be able to tell them where pain is. They might ask you if you need pain meds for after. Tell them yes because the next two days will be hurting more than normal due to the irritation from test.
    It is a test that should be done to make sure they get right disc. I am sure yo9ur nuero knew where it was by symptoms. This just confirms it. If a disc isnt bad it wont hurt. This test is the gold standard for surgeons to dertermine whats wrong and it is pretty hard for insurance company to deny it afte a positive pain results. It is the one thing that got me approved. And I have the worst company in the world. So cheer up, This should give you your go ahead for surgery, if the discs show problems.

    I hope this helps. I had to have 2 of them becasue the first one wasnt recorded pressures. Make sure that they record the prssures and everything while they do the test or it will cause problems for you. Call the place where it is being done and make sure they do pressures or it will lead to problems a mine did. I had to drive 3 hours away to get it done that way. PM me if you want. Hope you feel better after this, and make sure the discogram is done right or they can refuse it. I fought for 4 months because of it.
  • To some extent I am speculating here, but please bear with me.

    Surgeons try to thread the needle to find just the amount of surgery the patient needs to deal with the pain or "fix" the problem without doing any more than is necessary.

    I imagine your surgeon was planning a one level fusion based on your two previous surgeries. He probably saw no evidence to suggest you had problems at another level. He probably felt fairly certain that the fusion at L4-L5 would solve your problem. In a way he was playing the odds. He felt sure enough about it that he didn't want to subject you to the pain and expense of a discogram.

    I know both my surgeons would proceed this way. They almost never send a patient for a discogram unless there is a great deal of uncertainty.

    Now that the insurance company wants "proof," he probably figures that as long as they are checking the one disk, they might as well check the adjacent levels "just in case."

    Hope your spirits have picked up after your walk in the garden.

    xx Gwennie
  • Thank you for your encouraging words.

    I do feel a lot better now, knowing that this may be exactly what my insurance company needs. I so want to see an end to this ordeal!

    I will definitely consult with them regarding the pressures. I think it will need to be done to the insurance company's satisfaction, too, Robin. Thanks for the tip!

    Yes, the gardening did help! Thanks! I have new strawberries that I am babysitting so the birds don't eat them :)

    I feel tons better now... I guess sometimes we just need to get stuff off our chests and know that we are not alone in what we go through, even though we wish others didn't have to go through any of this.

    Thank you again!

  • for long term disability then what are you worried about? Just try to get to the bottom of your pain.

    good luck!

  • I have to add that I think the Discogram is WORTH it!

    I was not convinced I needed surgery until the Discogram.

    ALSO -

    My Discogram showed that the disc that was hurting the most was not the one the dr. would have fused originally. The disc that looked the worst was not the one hurting the worst. I am very grateful for the test.

    The actual test was difficult - I really really hurt, despite the pre-test anxiety meds. I was very brave though and managed to get through it without embarrassing myself.

    The next day I had off work because the nurse told me I would need it, that I'd be hurting a lot. As it turned out I felt only mild stiffness and soreness the next day.

    Best of Luck!
  • I can't imagine not having one done.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • I'm glad I read this, because I will probably wind up having surgery somewhere down the line, and I will ask for a discogram before so that I can be sure we are doing the right thing. I am certainly apprehensive about doing anything that might add to my pain including a discogram, but you know what, surgery will be even more painful so you want to be sure they get it right.

    I also agree with gwennie, your surgeon probably wanted to operate on the disc that looked the worst from the mri's but now that you are getting a discogram thought it would be a good idea to check the discs nearby too.
  • Thanks for your comments and input.

    I am totally fine with having the discogram, even if it is painful, to accurately diagnose the correct offending discs.

    I wish they had ordered it before the fusion was scheduled so I wouldn't have had the problem with the insurance company. It's all good, though. That was yesterday, today is different.

    To answer the question about being approved for long term disability... the thing is not the income, that is not a huge deal (although I don't want to have to pay for my insurance), it is that I will lose my job and I love where I work and the people I work with. I have a great 401K and stock purchase options. But, I guess what will be will be. I can't worry about it anymore.

    Thanks again,
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