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fusion surgery denial

Wanted so help and advice on a lumbar fusion surgery denial.So far I have been denied twice.Now I filed a complain with the Insurance department commissioner.Anyone else been thru this?I am in such need of this fusion.



  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 11/07/2014 - 7:08 AM
    Is it a "Not medically necessary" denial? First I'd check with your insurance company that it's not a coding issue. Maybe they want you to try more conservative things first. There's a whole section on insurance type issues. Select "Mind/Body/Spirit" at the top left of the screen & follow the link. Best of luck. Others have shared your experience.
    Osteoarthritis & DDD.
  • I am also currently facing this issue with a disc replacement surgery. They said it wasn't medically necessary, but I've tried everything else for the past 18 years. I was advised to have my surgeon call the insurance company directly to convince them that it was a necessary surgery and all other avenues have been explored. We are now waiting on the insurance company. Perhaps give that a shot. Good luck!
  • Because of the overuse and (given) sometimes spinal fusion surgery is actually counterproductive to a patient, we want to make sure our members are receiving the quality services they need and are not getting something that's not appropriate for them," Chambers said. "The studies support that non-surgical interventions over a period of time can result in the same benefits as having the surgery.
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