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Insurance @$#%^&- my surgery has been cancelled/postponed

JulieAJJulieA Posts: 1,420
edited 06/11/2012 - 8:37 AM in Neck Pain: Cervical
OK- I had my pre op meeting with my NS this week and the nurse had said insurance had not come through yet. I even had the pre op hospital check in....

I have double insurance. The secondary Blue Cross Blue Shield approved it, however my primary denied it. I almost knew they would. They denied the last surgery and we appealed it, (it was approved). They told my NS nurse that I need to have 8 weeks of PT before they would consider it. My NS says that we don't usually ask for PT for cervical spondylolsis (sp) with myelopathy. My incident happened in May.

I am disappointed to say the least. The thought of PT right now makes me cringe- I fear the pain that is sure to come.

I thik we are appealing the denial like last time- I will be calling my NS office to follow up next week.




  • I'm sorry that you are going thru this with your insurance company. I hope the appeal works and that you don't have to wait 8 weeks.

  • I'm so sorry you are having to have this battle to get your surgery. In the same position myself, very frustrating and almost crazy. Hope the appeal goes through without any hassles. Funny really, surgery scares me to heck and yet I'm fighting to get it. Wishing you Giant gentle hugs n' Loves - Paula
  • jlrfryejjlrfrye ohioPosts: 1,110
    I deal with ins companies on a daily basis. First of all request an expadited appeal. State the insurance company is causing you unnecessary pain and possibly permanent damage by delaying your surgery. Also state how this is affecting your mental health. Supply medical documentation of your diagnosis along with all treatments to date.(I know it sounds stupid because they are the ones that paid for it in the first place.) Have your NS write a letter of medical necessity and how it is not normal practice to send a patient to pt for your condition. Basically leave nothing out of the appeal so they cannot delay a decision. Once again it is an insurance company that believes they know whats best for a patient instead of a doctor! Good luck and I hope you get a decision quick.
  • Thanks for the support.

  • That really sucks. I'm so sorry. That is why I'm only on Medicare so I don't worry about the supplement plan sticking its nose in my business and grinding things to a screeching halt. The down side is that I'm responsible for 20% but I don't have to deal with these kinds of hassles.
  • Isn't it amazing that insurance companys are all doctors }:) I had the same thing happen, but in my case it was for a diagnostic MRI of my lower back. The insurance co said I hadn't tried all other measures yet, and recommended PT instead. Both my doctor and I appealed, my PCP said it was a medical necessity, and he didn't want me to do PT until we found out if my bulging L4-5 and stenosis was worse. I lost the appeal, so did 24 sessions of PT, costing me big bucks. So almost a year later, pain getting worse. Now I'm afraid to request another MRI and get turned down again. I hope that your insurance co listens to your NS and gives you the okay for surgery. At this point sounds like PT would only make things worse. Hang in there, and bombard the ins co with facts!

  • I was up and working at 4:30 am. I think the only time I sat dow today was the car drive to the base and back. I was literally on my feet working from the time I woke up till now.

    My hands have been buzzing for 48 hours and today I have sciatica in my left buttock (thats brand new for me it was always my right).

    I have to go work in the concessions stand for my daughters volleyball team tonight. Yikes!

    I took a norco and a flexerile at 12 noon. I will take another norco after I get to the school. I also have a cold and my voice is almost gone :O)

    Wish me luck.

  • Julie
    I have had success appealing insurance decisions. You should ask for an expidited appeal which usually they have 3 days to respond to this. I would check your insurance book.
    I also included as much medical records as I could . I underlined and put in my own comments on the reports. On the letter that I wrote,I repeated often that their withholding and delay of treatment will cause me permanent damage.
    I got my approval the same day! Let them know your not stupid but well educated on your condition.
    Good Luck, Bethy
  • That is awful, I would think that if their is any myeolpathy going on they would want to get you in for surgery soon.
    P.T. before surgery with myeolpathy doesn't sound safe.
    Maybe the Primary ins. doesn't have in their notes that their is myeolpathy going on.
    Just my experience and opinion.
    Good luck,Julie

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