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FJI's suggested to confirm lumbar surgery necessity for insurance.

candrews922ccandrews922 Posts: 21
edited 06/11/2012 - 8:56 AM in Spinal Injections
:T :?? Okay, lets see if someone out there, can help me with this one. I have stenosis confirmed in 2 areas, lumbar and cervical. Lumbar at L4-L5, L5-S1 is being addressed first. Saw a neurosurgeon yesterday, who was covering for another Dr. while having to do his own patients. My appointment lasted 3 hours, with him running in and out. When he was finally ready to talk about my MRI's and options he was an hour and 1/2 behind. He didn't have time for any questions, said I needed Facet injections so that all conservative treatment so far, along with the effects of this injection will prove I need surgery, thus making my insurance happy. Here is my confusion, I am pretty sure the result will need to be positive in order for him to do an Anterior Ifix putting in a device and metal cage by zimmer-spine. I asked if I didn't have surgery what would happen and he just looked at me like I was nuts. Any input appreciated. Thanks.


  • I had to have these shots to prove they didn't help before insurance would pay for the surgery, even though the doctor told me they wouldn't help. He said insurance requires you to try all conservative therapy before surgery, even in cases where they know it won't help. I guess they have enough that it does help that it saves the insurance money in the long run. I had the same thing when the hardware needed to come out. PT, shots, drugs, another round of shots before insurance would give their ok. Not to say the facet injections won't help you, they may. If they do you can keep from having surgery for a while longer, or possibly never need the surgery. The surgery runs upwards of $90,000 and the shots around $3-5,000 so for the ones it helps they save a lot of money.

    I forgot to ask what's causing the stenosis, mine was unstable spondy so nothing would stop it but the surgery.
  • ~X( The main symptom I am concerned with is neurogenic claudication. Pain is part of it for me, but even more is my legs stop working normally. Since my appointment I have researched more, and my insurance considers what the neuro wanted to put into my L4-L5 disc space is still experimental. I have read varying reports as to what the requirements are to have to have surgery. The facet joint block isn't a necessity, and from what I can tell, they aren't going to cover what he wants to do anyway. I am at a loss, at the moment, just frustrated and pissed. I waited months for this appointment, after various tests and precertification blah blah. Then the Doctor I am seeing had to cover another Docs patients and his own, and I was there at the office for 3 hours and the doc ran in and out, and had no time for me. He was an hour and 15 minutes behind, by the time he ended my appointment, which made whatever he was going to cover a wham, bam, thank you mam. I asked what would happen if I didn't have the surgery and he just looked at me like I was crazy. Not a happy camper.
  • Did he want to use BMP in the disc space? I had that done at L4/L5. My insurance considered it experiemental but they pre-approved it. Maybe it would be covered you always need to get it approved first so you don't get suprise bills. If you have questions maybe call the office and talk to his nurse or assistant. Everytime I had a question I called and asked to speak to his nurse, if she couldn't answer it she would call me back after asking him. Also if your not happy with your doctor, get other opinions. You should always trust the doctor that your having do surgery on you, he has your life in his hands, not to mention your ability to move.
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