I received a denial letter concerning fusion surgery. Dr's diagnosis: 1) Lumbar scoliosis. 2) Multilevel lumbar DDD. 3) Lumbar central and lateral recess stenosis. 4) Lumbar foraminal stenosis.
I have had severe left leg pain both upper and lower, pain in my buttocks and lower back, and initially a shooting pain from my foot to my hip.
I have received 3 opinions from 2 Neurosurgeons and 1 Orthopedic surgeon recommending fusion surgery. I have been dealing with severe lower back pain for 8 months, 7 chiropractor visits, PT for 2 months, 2 rounds of facet injections and 1 lumbar injection, PT again for 1 month. I had scheduled the fusion surgery with a well known and respected neurosurgeon only to find out my insurance would not cover due to it not being medically necessary. Has anyone out there had issues getting their insurance to cover surgery or treatment? I'm a 59yro male that in the past was very active, mainly golfing and fishing and working out 5 times a week. Now I cannot walk around the block with my dogs due to leg and lower back pain. I have a sneaking suspicion that maybe my Neurosurgeon's office did not submit enough info on my behalf to the insurance company. The surgeons office has refused a peer to peer review and thrown it back to me to appeal and come back when I have the approval. Maybe I'm just turning into a wimp but I want to get off my pain meds and get better. Any suggestions from anyone? I'm just looking for some suggestions I guess on where to go from here.
Thanks for any feedback