Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Insurance decline surgery date cancelled :(

SplendagrrlSSplendagrrl Posts: 108
edited 06/11/2012 - 8:56 AM in Back Surgery and Neck Surgery
After 3 years of pain steadily getting worse I finally had a surgery date of Oct. 17 th. Had a pre op appointment Oct. 10th. Everything was set!! I have excellent insurance and have never had a problem before not even with my neck surgery, but today my insurance declined my 2 level spine fusion surgery! I can't believe it I am so upset!, so my surgery consultant has to cancel my surgery date and she said they had to wait for a reason and then would appeal which could take 30 to 60 days!,,This has made me cry today I am so upset and am feeling miserable. With my back pain and leg pain getting worse Dailey I did not know how I was going to make it till the 17th and now I don't know how long I will have to wait! This week have barely slept at all, not to mention the stress I have already suffered just waiting for the surgery date to come. So anyway I decided to call my insurance and find out why. They said they want me to have a diseconomy first to see if that works before a fusion is necessary. As far as I understand that my help the nerve pain in my legs but won't help my mechanical back pain. So I know I would end up having two surgeries this just seems ridiculous to me!,, anyway I called and left a message with my surgery consultant today and told them the reason why because they were still waiting on a fax. So right now I have to wait and see what the surgeon is going to do. Either go ahead and decompress first or if they are going to go ahead and appeal. I can't believe everything planned is a mess and up in the air right now. Anyone with any thoughts about this or decompression surgery etc???????


  • Splenda >:D<

    I went through the same thing twice! It is common practice. They never went as far as to tell me what surgery I need to have thought. If you have instabilty then IT should say so in your file. A discectomy will not help instabilty.

    I am sure your surgeon will get through the appeal process and get you your fusion approved.

    My PLIF was delayed only about 3 weeks in all. I caught my insurance compnay in a lie. There NS ended up being nothing but a medical examiner. He did not stand a chance on the peer to peer review. I called them and had them mail (certified) my complete file and notes etc that they shared with the peer review doctor- when I finally recieved the notes I googles his name and found his website and medical examiner license.

    On the ACDF I did have to complete another 12 weeks of PT before they would approve my surgery since the EMG guy said I was negative and only needed PT. It was aweful since I wanted to have the surgery in November and finally when I was approved my NS was on vacation for 4 weeks (first time in several years BTW).... It ended up being the following March.

    Hang in there. If you need to go to the ER for any reason- don't hesitate (make them pay).

    Feel better,

  • So sorry that things are delayed. I know what it's like to come to a decision to have surgery. I don't know what it's like to be declined but can only imagine.

    I hope your surgeon gets through the appeal process quickly but either way, I really hope your pain doesn't increase. Keep your chin up...I know, easier said than done.

  • It could be how your doctor worded "your needs for surgery" by him. Like Julie mentioned 'instability' is a bit of a biggie, and there isn't much that can be done short of a fusion (about to hit the road myself). I reread your post and didn't see that as an issue for surgery.

    You mention nerve pain and mechanical pain, but not why. Sorry, I am sure you listed it somewhere and I am just missing it. The insurance is going to try to push the medical side of the house to go the least invasive and costly ways first unfortunately.

    I know they went through my insurance a week or so ago, and I've heard nothing, so I am assuming all is still a go. Time will tell, but I don't see what they can say about mine. Hopefully your doctor will be able to get this knot untied and you back on track sooner than "30-60 days".... Fingers crossed and thinking of you woman. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I am so sorry your insurance denied your fusion. It's unreal how the insurance companies are making our health decisions. Last April, my NS, told me I needed a fusion. This was going to be minally invasive. Insurance kicked that out. So we regrouped. The surgeon wanted to do an axialif 2level. They wanted more info, they sent to them. They denied it, reason being, experimental. Next was the peer to peer, that was denied for the same reasons. Then he asked for a expedited appeal. That was upheld. So he sent me 2 other surgeons, another NS, Orthro spine surgeon. And the other doctor was pain management. He did my discogram. They all agreed I needed an ALIF 2level l5/S1. The date.Oct. 17. I had my
    ,, appointment with my GP today. He ordered my pre-op. I told him they might not approve the fusion, and I didnt want to do them again. So I think around Oct.7, maybe they'll know more then. I'm trying not to worry but I can't stop. Nothing about insurance is right. Hang.in there. Take care, Brenda C.
  • Sorry to hear what the insurance company is doing to you, and any stress will increase your pain.

    In Australia, we have a different medical system, so I don't know what it's like to have a surgery date and then get knocked back by the health insurance company.

    I had instability in my spine and the neurosurgeon did a laminectomy/discectomy, which increased my pain and I was really miserable. After about a year, I found a neurosurgeon who told me that the lesser surgery was the wrong treatment for spondylolisthesis, and only a fusion would open up the space and the leg pain would eventually go. That's exactly what happened. I'm still left with some back pain, but it's manageable.

    Hope your doctor can sort out things for you and that you'll be able to go ahead with a fusion soon.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Just wanted to thank everyone for your replies and taking the time to give them. It means so much when you are feeling down to know there are people out there that really care! :) and in case you haven't read when the insurance talked to my surgeon and got all the facts my surgery was deemed medically necessary and they overturned their decision and approved my surgery! I am so thankful for that and this site in my time of need! Now to get mentally prepared for Oct. 17 th which is suddenly only two and a half weeks away!,,
  • Good News :)

    Finally you can start putting this behind you.

Sign In or Register to comment.