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MY Insurance is denying my surgery:(

AnonymousUserAAnonymousUser Posts: 49,607
edited 06/11/2012 - 7:19 AM in Back Surgery and Neck Surgery
I just wanted to get some opinions and some support about this.....

I found an AWESOME!! Spine surgeon in the Denver area....I went to him..showed him my latest MRI and he says that I need a level 2 spine fusion done....YEA....I can finally get some relief....NOW my insurance..not WC or someone elses insurance..but MY insurance is denying the surgery...I want to scream at them and tell them if you had to walk in MY body for a week you would scream too!!!

My pain has gotten sooo much worse since my 2nd ESI..I think that Doc hit the disc;(

So now I am trying to find out what I can do to get my insurance to change there minds.....I really need this done...any suggestions???


  • is terrible news. I am so sorry sweetie. Is there an appeal process that you can do and if so have you started it? I hate to say this but you may even end up having to see a lawyer about this if it gets too bad.Please keep us posted as to what happens. I wish you the best of luck....take care...Miki
  • I am waiting now to see if my surgeon can convince my insurance to get off their A%# and help me...I should hear from them today...I had to break down and tell my Doc of the bladder problem that has come up:(:( HOW embarassing:(:(:( :jawdrop:

    I am only 35 and I feel alot older and my MOM just told me it was pretty much all in my head;(:(:( I am soo down right now!!

  • Hi

    My wife and I have to fight the insurance people often.

    Good Luck to you.

  • am so glad that your doc is helping you with this. Also , don't be embarassedabout telling your doc things. Remember he hears stuff like that every day sweetie and it is info that he needs to have to be able to treat you properly. I will be praying for you hon....Miki
  • That's just wrong!!!
  • I dont really know why its being denyed...they said THEY dont think that I need the surgery:( Well if they could feel what I feel then they wouldnt say that!!

    I just dont understand and its driving me crazy :?
  • Your doctor has a lot of pull, and if he thinks you need the surgery, he will likely write a strong appeal letter on your behalf. You may want to obtain a 2nd opinion from another surgeon, so that you have a stronger case. Try not to worry too much. It is difficult to have patience when we are in pain, but if your surgeon fully believes you need this surgery, he will fight for you.

    Sorry for your pain and frustrations.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Thank you Neck, I really appreciate that:):)

    I would get a second opinion but I am SOOO broke that I dont have the Co-pay:(
  • I just went through this. I know how scared you are. Hang in there. I am sure your surgeon will be able to convince the insurance company that you need the surgery.

    I ordered my records pertaining to the request from my Insurance Co so I could personally go through the request and I wasn't surprized by my decline because the information that the insurance co sent to the outside md-(for the approval) was missing some important information.

    My insurance offered a peer review- the NS called the MD with the insurance and they spoke about it.
    I received my approval yesterday. ;)

    Hang in there,

  • Hello Julie, congrats on that one, mark one up for the little guys,LOL:)

    I really hope that my Surgeon can do some good, he is a totally FAB doc who is great at getting to the point;)

    I hope to get to know all of you better and become Spiney friends;)
  • There's a book you need to get to fight your ins co. You can only get it on-line at the insurancewarrior.com. It talks about fighting for yourself. It's about $20.00 and is well worth the price. The author will then help you on-line as needed. Best of luck in your fight and hope you get what you need!

  • Mmarsh, thanks for that web site, I am going there now;):):)
  • I am so sorry that really stinks!!!!! Insurance companies can be such a pain in the (neck and butt) literally~ here's a hug.......image
  • Oh Cherry, thanks for the hug:)

    I will keep you all informed about the insurance company from H#%L...can I post the name of it here or will Iget in trouble???:):)
  • No Polly, you won't get in trouble by posting the insurance co. name (only doctors are subject to "gag" rules). Let me guess - Aetna or Cigna? I have to say, I have been very please with my Blue Cross/Blue Shield coverage - nothing denied with the exception that I now have to pay for my physical therapy - only 15 sessions allowed per year.
  • They will approve once your doctor has written a letter explaining how serious your condition is. Insurance so's are afraid of being sued, and once you get your doctor to write aletter tha can be documented, they will budge.

    They figure thast a certain % of people will give up and they wont have to pay. Once you prove you are not going away and evidence is being documented, they will want to avoid a lawsuit and cough up the cash. I wouldnt worry about it. And yes, read that book. Also, I think the author of that book is for hire to help you get it approved. Its worth looking into if the appeal fails
  • Thank you all again:)

    My Insurance is Anthem Blue Cross/Blue Shield;( They denied my 3rd MRI till I went to another Dr and then they said ok....I am wondering if the other Spine Surgeon in MY Dr's office can be the "2nd" opinion???

    My Spine Doc wants me to come in again next week, he wanted me to come in today but I dont drive and his office is 75 miles from mine;(. He wants to see me for my occasional loss of bladder control( not a fun thing to admit too:() So I dont know if he is waiting to talk with the Insurance people till after he sees me again???
  • That bladder control issue is critical. It is usually considered emergency surgery by that point. Make sure the doc tells the ins co about this symptom. I can't believe you're getting squeezed like this, but BCBS has begun a campaign of denial and as Steve said they hope you'll go away! Keep fighting!

  • They denied my injections!
  • Well I have been told today that the Insurance from H#$L wants Flex x-rays...the only thing I didnt have when i went in:(

    So now I have to go into the Springs and get them done....

    I am wondering if the Doc told the insurance about the bladder issue??

  • Bladder and bowel is usually considered urgent!! You call and tell them and make a huge deal of it! Demand to know why and ask what they are going to do. If you can get your doctor to in writing to state that this is now an emergency, they may not have a choice. Look at your benefits and talk to your doc and see under what circumstances would he perform the surgery under "emergency".
    I just go the book from the Insurance Warrior Laurie Todd, please go the website www.theinsurancewarrior.com
    BCBS in writing should be stating why they are denying, call and ask. Keep a notebook and file, write down everyone you talk to dates, subject etc. Get your MRI and medical records copied and keep them with you, if you need them for another MD or BCBS you won't have to wait plus many offices will charge if they have to copy them more than once. I am fighting LTD and everytime I see my doc they send me a copy of the office notes and I have an ongoing binder. Had an MRI done yesterday and I was able to bring in the last 2 MRIs plus reports for everyone I have ever had. Radiologists like to compare films, not reports.
    Push back at the bullies, I realize this is emotional but to them this is about $. They are going to put things off as long as they can. Don't trust anyone that works there, they may tell you something that is not true (the only truth is in writing in your benefits handbook).
    Good luck, I am truly sorry that you are having to deal with this.
  • Thank you for that Mom...as soon as they( the doctors staff) get back from lunch..I will tell them that a friend of mine that has had lumbar surgery told me that any bladder control problems are considdered EMERGENCY...my insurance does NOT need pre-authorization for emergency surgery!

    I am just getting really scared and embaressed;(
  • As others have mentioned before, any loss of bowel or bladder control is one of those symptoms that should automatically bump you up on the priority list for medical attention. Here is a link from this site that may be of use. I know that whenever I go in to see my surgeon, he asks about those type of symptoms. I've even had PTs ask those questions, as it is one of the symptoms they look for. I hope you get this resolved quickly so you get some pain relief!

  • I talked with the Doctors assistant yesterday and he doesnt want to go the emegency surgery route;( :jawdrop: He wants to try and get the Insurance company from H#%L to authorise it.....I had to go and get Flex x-rays last night....and the doc's office has me schedualed at the Monday morning for my surgery even though the Insurance from H#$L hasnt authorised it yet;(??

    My Doc's assistant is thinking she can get them to ok it by monday...I am going to have to reschedual it for next week:)
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