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problems with surgery denied

Where do I begin? I have Posterior Central Disc Protrusion At C5-6 Produces Canal Stenosis And Indentation Of The Ventral Cord Syrface W/o Severe Cord Compression. Smaller Bulges And Protrusions Also Seen At C4-5 And C6-7. Asymmetric Facet Arthropathy Results In Distortion Of The Right Neural Faramen At C4-5. Blah blah blah? Basically, I am in a lot of pain. My insurance has denied my surgery twice based on the fact that I have not had 3 months of recent failed physical therapy. I have done many other therapies just not PT. So now I am getting PT so far for 3 visits, (basically to jump through the hoops). My question is will the insurance company hold me to that 3 months? My PT seems to think that after 6 visits she will call them and tell them that she cannot treat me anymore due to no relief and that they will then approve my surgery. Is this common? Anyone else dealing with this?


  • dilaurodilauro ConnecticutPosts: 9,858
    doing this.
    As long as the surgeon provides the insurance company with the correct justification and rationale, the insurance company should just be a rubber stamp.

    Many times when I have seen Insurance company denials, it was because the doctor did not properly put the request together.

    Then again, this is 2014
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • When I had my hips done, my insurance company did not require this.. However the doctor said my insurance would not pick up my surgery if i didn't do atleast some rounds of PT and said it failed. Basically I would go to PT for a couple of times, tell your doctor it hasn't helped and it's making it worse ( if that's the case) and then talk to your insurance company. I know some do require PT before surgery just to exhaust all conservative measures before surgery. I know it's really unfortunate they do this espicialy when you are in pain. Stick with PT until further notice though.
    28 F. Chicago. Fusion from t-12 l-4 from scoli in June 2013. Torn bilateral hip labrums. Arthroscopy to fix labrums January 2013 and march 2013. SI pain from hip surgery Lupus, RA, antiphosphidlipid antibody- hypermobility syndrome ( Marfan syndrome)
  • I had an insurance company several years ago do something similar to me. They denied a MRI several times until I went thru a round of PT. The insurance stuck to their guns to and would not let me have the MRI until I finished the PT. Which really sucked because I was in a massive amount of pain.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • LizLiz Posts: 7,832
    edited 01/29/2014 - 8:22 PM
    Please take the time to read this post and refer to it when you have questions

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    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
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  • jlrfryejjlrfrye ohioPosts: 1,110
    My surgeon would have me go once or twice and then they approved. It is all a game so play it to win
  • leslie.wassonlleslie.wasson Posts: 4
    edited 01/30/2014 - 5:32 AM
    Thanks for all your input. Yesterday I completed my 3rd PT appointment and while I was there we were talking about female issues. I was telling her about the fact that I seem to have no control with urinating. Either I feel like I always have to go and don't or when I really have to go I better be close to the bathroom or I will wet my pants. I also don't empty all the way. She seemed very concerned about this and wondered if I told my surgeon about this. I told her I didn't, why would I he is a neck surgeon and I thought this was a female problem I would have to deal with at some point. She called my surgeons office so now I wait to see what happens now. Anyone else have this symptom with cervical spine problems?
  • jlrfryejjlrfrye ohioPosts: 1,110
    edited 01/30/2014 - 10:00 PM
    sure did, once surgery was done it stopped
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