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Normal MRI & X-Rays, but EMG showing L-5 damage

Stephanie_KSStephanie_K Posts: 2
edited 07/21/2015 - 6:47 AM in Chronic Pain
Hoping someone can offer help or advice. I am 41 years old, & have suffered back pain since an ATV accident as a teenager. Over the years (especially since having children) the pain has gotten worse. I would complain to my doctor, who would order x-Rays & then tell me everything looked normal (except for mild scoliosis) & prescribe pain pills & muscle relaxers. Last fall I finally asked my doctor to do something more- I don't want to spend my life doped up on medicines that don't eliminate the pain but make me sleep through it. They ordered x-Rays, which again were normal. They then ordered an MRI, which also was normal. At that point, I once again felt like everyone thinks I'm making it up. They referred me to a pain management doctor. This doctor ordered an EMG, & finallyI got some answers. They determined an irregularity with the L-5 nerve, & suggested a cortisone injection into the nerve. That was done last December, & finally, for the first time in longer than I can remember, I was 100% pain free! It was amazing! Now, 7 months later the pain is beginning to return. As directed by them at my follow up in January, I called and scheduled another injection. I arrived yesterday morning at their office for the injection, only to bet old that the appointment was canceled because my insurance refuses to cover it. The MD for my insurance company wants an MRI to 'prove' that there is a problem. Even after a 45 minute talk with my doctor, who explained my history, and the fact that it was diagnosed by EMG, not MRI, insurance denied my request for an injection. They claim my only option is to have a repeat MRI, the results of which would determine if there is any reason for an injection, or a surgical consult. My doctor told me there is nothing that can be done surgically for my problem. The way it was described to me, the nerve was most likely damaged at the time of my accident. Because the spine is not pressing on the nerve now, an MRI is not going to show anything. But the nerve is still damaged. I don't want to live the rest of my life in pain! Does anyone have any suggestions to offer?


  • LizLiz Posts: 7,832
    edited 07/21/2015 - 9:00 PM
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    Spinal stenosis since 1995
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  • Hi Stephanie. I'm so sorry. I'm having my own insurance problems at the moment & it's infuriating!! Have you tried phoning your insurance company? In the past the telephone person has been really helpful, giving me tips on how I can get around issues like this. Sometimes it's a coding issue or your doc hasn't listed that EMG shown nerve damage as the purpose of your visits...I know that sounds silly but I've had that problem in the past! My visits were listed as "Spine Damage". My insurance company tried to deny SI treatments because I'd never had doc visits for SI damage. SI joint isn't spine apparently!! If your doc has been seeing you for "nerve compression" that could be the issue. I've had a similar issue with muscle spasms. Ugh!
    In my experience some specialists are great at filling in the forms & I never have any insurance problems, everything & anything gets paid for no questions. Other specialists seem to get loads of things denied. Spending hours on the phone drives me crazy but often helps. If the insurance phone person isn't willing to help call back & get a different one. A good one will tell you who needs to do what to get this approved. Best of luck. I spent 3 hours sat in my surgeons waiting room last week & had to leave without seeing him because of insurance craziness. I know how frustrating it is!
    Osteoarthritis & DDD.
  • EnglishGirl- my husband has spent a lot of time on the phone with our insurance company. In addition, the NP who is treating me spent 45 minutes on a video chat with the insurance company doctor in charge of my case. She went over my entire history with him. He still denied it. She asked to speak with a different doctor, & he told her he was the only one she could speak to about my case. I asked her a few more questions, & asked about getting a prescription for a pain medicine. She replied to me, answering all my questions except the pain medicine. No mention whatsoever about that. So I made an appt with my family doctor NP. When I arrived & started explaining my situation, the nurse stopped me and said she didn't think she could help me, without getting permission from the pain management doctors. She went to call them & came back telling me that I had to go through them, or I would be 'breaking my contract' with PMC. So I left & called PMC, only to be told that I had to go to my family doctor, & that I had no 'contract' with PMC. Needless to say, 3 hours, 2 doctor's office visits & countless phone calls later I have a prescription for Tramadol, & am unsure if I still have a dr appt on 8/5 at PMC, or of I'm even still a patient there. It seems they only want to help their patients if they can make money off insurance companies. If insurance won't cover services, the doctor wants nothing to do with the patient.
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