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Insurance Co Problems, Here we go again Updated Good News

iowarobiniiowarobin Posts: 1,268
edited 06/11/2012 - 8:42 AM in Health Insurance Issues
I was supposed to have my discogram on Friday in Mpls. In Iowa there is no place to get a weighted discogram. Thus, going to Mpls.
The discogram office called on Mon and said I needed to have 5000.00 for the procedure up front as it is out of network. I told the gal it is, but since I cant get it done in Iowa, they would have to pay in network rate. She then told me that they said I have a 10,000 ded and I explained that that was out of network and my in network was 5,000 which after a CT last week was met.
She called back and said they had given her different information each time that she called. So I called my Ortho office that is dealing with it and explained the situation. So yesterday she called me back and said they wont pay in network, if there is anywhere in Iowa that can do it. I called the Ins Co and asked to have a list of in network that do this procedure. Cant give it to me, don't have that detailed info. So how can I get it done, I asked. Ins Co rep told me to ask for authorization for in network rate for out of network because I cant find a Iowa one.
So ortho office called and they said it would have to be checked internally and that they couldn't guarantee me that it would be done by Friday. I have to let the place know on Thursday if I cant do it. The kicker is, I had this done 1 1/2 years ago at the same place and they paid it in network for the same reason. But the Discogram place wants the 5000.00 down, in case it isn't paid that way. Even though they clearly have records for the time before.
My only problem is, I would go ahead and do it, but if for some reason a place turns up in Iowa, I will have to pay the 10,000 out of network charge. And I cant take that gamble. So, I will have to wait for another month for a appointment, because they cant tell me if there is a place here that can do a weighted discogram.
I can get a regular discgram done, but the last fusion, they wouldn't accept the results of it because it is not accurate enough. So I am stuck. Waiting again. They do everything they can to discourage you from going further with procedures that are expensive. Go Figure.
I was so looking forward to getting some answers, and now, its another waiting game. ARRGGGG X(


  • SpineAZSpineAZ WiscPosts: 1,084
    You may have mentioned this before, but what are they hoping to find in the discogram? The reason I ask is that there is a lot of debate currently in the orthopedic/neurosurgery world about how much discograms really help determine what is truly going on in the spine. My surgeon debated whether I should even do a discogram and did opt to have me undergo one. But as it turns out the results were of no additional help. Is something like a CT myelogram a viable option?

    And, if you could help me - what is the difference between a discogram and a weighted discogram. I had my "regular" discogram done at the pain management doctor's facility and the cost, if I had to pay out of pocket for my deductible or if I had no insurance would have been frond $2000 (with CT after) based on what I've seen on my insurance Explanation of Benefits.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • there Robin.
    I'm sorry you have to go through this.
    I hope an answer to your problem can be found quickly.
  • the Orthos office called me this morning and told me that they got approval for it, in network this morning. I had cancelled my appt, but called right away and they still had it open, so I get it done after all. I did email the CEO of the Insurance Co, the one for Iowa/Nebraska and told him exactly what they were doing to me, by making it impossible to keep my appointment. I also told him how bad the pain was, how long it has been this way and everything. So I am thinking that maybe this somehow made the process go alot faster! Worked the last time I had problems.
    And I know that all my friends saying prayers for me, gave me a big edge. Cause the big guy upstairs has more to do with how things work out than anybody!'
    SpineAZ, the weighted discogram test involves having the pressures and amount of fluid injected monitored by some kind of machine. It records the amount of cc's and pressure on the disc. A regular one, the inject the dye, and you respond to the pain. It doesn't record pressure. I had both done, the last time and my insurance wouldn't allow the fusion based on the regular one. But when I had to appeal it, the appeal Dr said that they are valid test as long as they are weighted and blinded,(you cant see what they are doing) and the CT confirms with the dye where the tears are.
    I went through all the myleograms, Ct's MRIs and nothing showed the disc problems. After 2 years a Spine Ortho, told me to have discogram as he said that MRIs dont always show small tears. It discogram confirmed it, and the regular discogram showed 1 disc with problems, where the weighted on showed that there were actually 3.
    So I am off bright and early for my appt tomorrow. I don't even care how much it hurts, as long as I can get it done and figure out something. I am so happy that I finally got a break from all the fighting with the insurance co.
  • I'm soooo happy for you.
    I hope it's not too painful and will help to solve the mystery.
  • SpineAZSpineAZ WiscPosts: 1,084
    So thankful this worked out for you with insurance.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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