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Insurance Approval

How long does it typically take to get insurance approval? I have grade III spondo with a lot of instability and leg nerve pain. I have heard about people not being approved and the surgery being canceled. I am praying this doesn't happen to me. I need to get this fixed asap. If you had issues did you find being the "squeaky wheel" helped you?


  • Mine took 2-3 weeks. A grad 3 spondy is serious though. It might be beneficial for both you and your surgeon to keep on the insurance comany. Left untreated that could cause some serious long term issues.

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • Bigshawn1234567BBigshawn1234567 Posts: 45
    edited 11/07/2012 - 10:26 AM
    I am about to have a four level fusion in my lower lumbar. I have two surgeons. One is a OS and the other is a NS. Going through my recent challenges I feel I am almost an expert.

    My original surgery was scheduled for Oct 3rd. I received a call from my NS office manager on Oct 2nd stating that my surgery was not approved. She gave reasons like Obama Care and Insurance was looking to deny my claim. The list of lies continue.....

    So I said, "Pump your brakes" , let me work on this. I have a insurance broker that can help me get to the bottom of this. She tried to discourage me from doing this, which made me want to find out even more. So I started digging around.

    Come to find out my insurance did not deny me. It was not Obama Care. Which is not even in effect yet. None of her lies panned out. During the course of this I found that with my insurance it is a 15 day process. The trick is to have the precert person tell the insurance that they need to put a rush on it due to unmanageable pain. Which in most cases is true. Sure was for me. By doing this it took only 72 hours to get my approval.

    But wait... Make sure they are on the stick with how they code stuff. My original NS ordered this monitoring that dealt with nerves. Insurance denied this monitoring because they claim there is not enough clinical paperwork to justify it so therefore it is classified as experimental. From here you have a couple of choices. First make sure it was coded right. And the other is a peer to peer. Most surgeons and their god complexes do not like to be challenged by a medical directors who are not in the trenches making lives better. So good luck having that done.

    So I fired my original NS because the office manager and her lies. It ruined the relationship between me and the doctor. A trust was lost.

    What I find most disturbing about this mess is: I am in sales. It's all about relationships. I treat my customers like gold. Medically speaking they are not relationship driven. It does not matter to them if you get fixed or not. Raising hell about anything will get you drop kicked out of their practice. So there is a lot of finesse involved.

    I have anew NS now and was able to finally get into see him last week. Everything is approved now and I am awaiting for the surgery schedulers to get with me on a date.

    Good luck to you. I would say don't take any crap off of them. But the truth is you will have to take some. Pick your battles and you will do fine.

  • Mine took about two weeks and the only way I even found out was logging their site. My surgery's just over a week and 1/2 away. Got through my primaries pre-test yesterday, hospitals pre-tests next week.

    XLIF 2-4 on 11-20-2012
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