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Insurance is denying my referral for spine specialist HELP.


Im 27 yrs old and my CT Scan reads

So I had a CT Scan done on my lower back since I've been having pain on my left side above my left buttocks that doesn't shoot down but is a concentrated pain.
The Scan reads: L5-S1 reveals broad based posterior central bilateral para central bulging of the annulus fibrosis producing a moderate bilateral L5 lateral recess stenosis.
L4-L5 reveals posterior central protrusion of the intervertebral disc producing a mild central canal spinal stenosis and deformity of the ventral surface of the thecal sac. There is moderate bilateral L4 lateral recess stenosis.

My orthopedic referred me to a spine specialist saying that they couldnt help me, unfortunately my referral was denied by my insurance. So not only do I not know what is wrong even though i have chronic pain in the left side of my lower back above my buttock especially when I sit down.

I wanted to know if anyone has any advice they can give me on my condition or its severity and what I can do about my insurance since my primary care doctor wont prescribe pain medication stating that its addictive.

Thank you!


  • I feel your frustration with your insurance. Where are you from and what sort of insurance do you have?

  • jlrfryejjlrfrye ohioPosts: 1,110
    More then likely the correct documentation was not sent in by the Dr office. I would call my insurance company and ask why the denial. It may be as simple as sending in the MRI report along with Dr notes to get approval
  • Well they are claiming that my illness is a pre existing condition and that I have had my back problems, probably the stenosis since before I got my insurance in Nov. 2012. Thats the reason the insurance gave me, Would it be possible to ask for a 2nd opinion? And does anyone know how bad my CT scan results are? My insurance obviously doesnt think much of it.
  • Chris if you were covered by insurance in 2011 it does not matter that it is pre-existing. Call insurance you had the yr. Before and tell them you need a form that shows you were covered by insurance for entire yr. And your new insurance must cover. We go through this every yr. Because our employers change insurance every yr so we go through this once a yr. So aggravating. If you weren't covered in the previous yr. Then that will be a problem. If I can help don't hesitate to send me a PM.

  • Hey, I didnt have insurance in 2011, I was denied by multiple companies for other pre-existing conditions. The company im dealing with is in Miami, called Preferred Medical Plan. Theyre saying since I had this before I got insurance with them that its a pre-existing condition and wont let me see a specialist and my orthopedic kind of washer her hands with me since they referred me out and said only a spine specialist would help. So do I have any recourse or....???

  • with your insurance company but we would have no way of knowing if it will work or not, but it certainly is worth a try.
    Yes, the ortho is correct, you would need to see a board certified ortho or neuro spine surgeon when it comes to back problems, or you can always pay for the visit /consult yourself and then see if the insurance company will reimburse you, but with them already denying coverage for a pre-existing condition, it may not work.
    As far as giving you any information about your CT scan, you really do need to discuss that with your doctor. No one here is qualified to give you any information on the report.
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