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Depressed,Need 2Level ALIF,Insurance will not pay!!!

brenda cannonbbrenda cannon Posts: 150
edited 06/11/2012 - 7:55 AM in Depression and Coping
Hello,how is everyone doing? I`ve been to my last NS...I`ve seen 5!!! They all agree. That is another big surprise!!! What is really sad, my insurance will not approve it!!! I won`t say which one.(that is against forum rules,right?) They all say it needs to be done sooner not later. The ALIF is the best option for the fusion. The surgeons, when they learned of my health insurance,all said, they won`t approve it til I`m using a walking!!! Number 1, who in their right mind wants a fusion? I don`t!!! My insurance premium is 1400.00 a month, and that is with a high deductable. I think I`d be happier with a health diagnose of a terminal death. At least, I`d know the pain would lead to a conclusion. A final countdown!!! For all you country fans,Live Life Like You Were Dying. Dang it, my body won`t let me do that. Take care all. Sorry this post was so depressing. I just needed to vent.
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Comments

  • Howdy Brenda,

    Sorry they are telling you this. I see part of this "refusal" as the fault of the surgeon or their staff. A lot can be "fixed" if the surgical request is worded correctly. Have all these surgeons told you this, or just this last one?

    I have Federal BCBS, and have had surgeons tell me "I can't get an MRI or multiple MRI's without pre-approval" which for my insurance is incorrect. So what I am getting at, until the refusal is written, and appeals also denied, I would keep pushing for the surgical approval.

    Almost forgot, you can call your insurance company and find out what the criteria is for your surgery as well. Then let your surgeon know, and maybe this will also help them in getting you approved...just my 2¢

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • LizLiz Posts: 7,904
    I am so sorry to hear you can't get your insurance to pay for your recommended fusion Brenda,I know how long we have been chatting about this so also know how long you have been waiting. It is upsetting after all this time that you still can't get it approved.
    Take care xx

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • What is a walking #1? Is that like going to the bathroom #1 or #2? If the dr,s feel surgery is needed and the sooner the beter and insurance wont aprove it sounds like a lawsuit in my opinion against the insurance company. First of all what is there reason for not aproving it? You said you have to use walking number 1 whatever that means. If that means a walker then ask for a walker and now they dont have a reason to deny it.

    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hey ya`ll... Thank you all for your kindness and taking the time to respond to my post. I`m in the process of doing everything to get all my stuff prepared. I`m really sorry for sounding so desperate! When I mentioned a walker,the last 3 surgeons expressed that Anthem Mo., literally were almost impossible to get Lumbar Fusions approved!!! They said(not my words)it seemed like they wanted the patient to be disabled, and in such bad shape,they needed a walker!!! I`m just feeling really sorry for myself and depressed!!! I hate feeling this way. I know there are so many more people in worse conditions and dealing with worse pain than I am. As everyone knows dealing with any ongoing pain,never being able to do normal things is so depressing. Life gaves us so many lemonds, it gets really hard to make lemonade!!! I feel so bad for my family, they have a hard time knowing or understanding why I`ll never be the person I once was,Surgery or not! That`s just the way it is. I am so thankful for the people who made this websit. Whatever anyone is going through something,SH is here. Everyone I`ve had the blessing of knowing or reading their post,chatting in the SH Chat, I think the world of all of you! I wish I could gave all of you big hugs! Brenda
  • Hey ya`ll... Thank you all for your kindness and taking the time to respond to my post. I`m in the process of doing everything to get all my stuff prepared. I`m really sorry for sounding so desperate! When I mentioned a walker,the last 3 surgeons expressed that Anthem Mo., literally were almost impossible to get Lumbar Fusions approved!!! They said(not my words)it seemed like they wanted the patient to be disabled, and in such bad shape,they needed a walker!!! I`m just feeling really sorry for myself and depressed!!! I hate feeling this way. I know there are so many more people in worse conditions and dealing with worse pain than I am. As everyone knows dealing with any ongoing pain,never being able to do normal things is so depressing. Life gaves us so many lemonds, it gets really hard to make lemonade!!! I feel so bad for my family, they have a hard time knowing or understanding why I`ll never be the person I once was,Surgery or not! That`s just the way it is. I am so thankful for the people who made this websit. Whatever anyone is going through something,SH is here. Everyone I`ve had the blessing of knowing or reading their post,chatting in the SH Chat, I think the world of all of you! I wish I could gave all of you big hugs! Brenda
  • Well if they want you to have a walker get your doc to give you a walker!! You can also try to threaten them with a lawsuit for permanent damage because they delayed your surgery. If your doctors will write something to this effect they may change their minds. Remember the squeeky wheel gets the oil so start squeeking!!
  • Great idea!!!...I`m getting that wheel oiled!...Thank you Kris, you made me smile. I didn`t know I could smile while crying! I`m sending you gentle Hugs!!! I will always love my friends in SH! You guy`s rock!!!
  • Like Kris said, get a walker (prescribed), and then see what they do with that! I also fully agree that the squeaky hinge DOES get the oil (attention). I can see them denying if you haven't tried conservative methods and all that, but other than that, they could be putting them in a bad position legal wise.

    We're here for ya woman!!! *HUGZ*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Ladies, I`m making plans for my next defensive action! I can now see, I never thought I`d need to handle my health care this way!!! Offense, is how I should have handled my insurance. How stupid of me, Fool me once shame on you, fool me twice shame on me! My only excuss,I thought my personal health insurance was on my side. Boy, talk about things have changed! So, I`m going to put my big girl pants on,tough up, and play hardball!!! Thank you all again! I think I`ll refer to ya`ll as the Spine-Health Super Hero`s!!! It feels so amazing to have the best people in the world,having-your-back,so to speak!!! Hugs,Brenda
  • What a difference a day makes! The orthro,spine surgeons in St.Louis called. Their proceeding with everything the surgeon thinks I need to have done. I really liked this surgeon, he gave me a great exam. He was very frank aout my insurance. Told me his experiance with Anthem was less than positive. He suggested I get in touch with my local ins. agent. So I did. He did his best to assure me Anthem would do the right thing. At this point, I hadn`t heard from him. So,I thought, he just was gaving me a pat on the head. Turns out he really got behind me!!! I`m so surprised, and pleased. Although, I can`t believe I`m happy to be having another discogram and mylogram. I guess I just know, they are very necessary. I want to get whatever I need done. So, at least for now we are making progress. Aug 22, is just around the corner. I`m finally going forward!!! Gentle hugs, Brenda
  • Good news and hope this insurance does the right thing. I know my Family Dr. told me they wouldn`t do surgery unless I couldn`t walk even though I walk with a cane and have a positive EMG showing a compressed nerve in my back they still won`t do surgery.

    I hope things are moving ahead for you. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • See there you go. All they needed was a litle push. Nobody will take no for an answer if they paying big money to have that insurance and dr says they need surgery. Its not the insurance decision to make if dr says it has to be done.its diferent if it was work comp doing it i would understand but not a private insurance.

    Now that the wheels are turning see if you can get them to pay for my sex change operation. I will just give them your name when i go in. Git-ir-done
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hey, sweetheart. I don`t really know what will happen after the discogram and mylogram. I`m just surprisingly happy about those test`s and going forward. Two years ago after going through all those test and more, my condition was diagnosed. The surgery I needed. L2/3L3/4 micro`d and lam. The oyher surgery, an Alif on L3/4L4/5S1. The surgeon told me sraight up what the micro`d would do for my leg,lower back,hip,waist,butt,leg nerve spasms,numbing. He then went on to explain what the lower levels alif would do for me, he was straight to me, explaining the success rate for each surgery. He explained to me even after the surgeries, I would always have issues, and that I would need to be aware and to make those adjustments in my life. After taking all this under consideration. I chose the lesser surgery, because, at that time, I couldn`t function with the L2/3L3/4. The micro`d-lam, was acomplete success. But the back and other issues never improved. Afew good days but never ever did my other issues get better. After, almost 2 years,I`m so much worse. As we all know,an Alif, or any kind of fusion, is really not something we want. It`s a huge surgery. That being said, the surgeons I consulted with have assured me I have no other options. One percedure,axialif level2, was the one my surgeon really wanted to do. Anthem Mo. will not pay for any minally invasive fusion or ADR. They just won`t. We`ve spent so much time looking for a easier route. Not going to happen. It`s has to be open. Maybe,that has been for the best. I`ve not found many success stories about the standard axialif. So,we will see. Charry,thank you for your good wishes. I hope you get some help. I plan on when able, to make it one of my causes, to stop insurance companies from making our health decisions. We pay alot of money for health ins. they shouldn`t be able to make our health decisions. What`s next, life and death panels? A operation to save our life or expensive drugs. Will it come down to one life is better to save than another? Hugs,Brenda
  • Alex,you really are a very smart and kind guy! I hope one day your able to get relief from all your pain. You always make me smile!!! As far as that other operation, America needs more male pole dancers!!! Do you ever watch America`s got talent? This year, there is a guy who`s doing that kind of dance! I would love to see you dance on that show!!! Git-ir-done!!!
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