Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

10 years of pain, insurance won't pay for last treatment option

apaulaapaul Posts: 1
edited 01/15/2016 - 11:43 PM in Chronic Pain
I was diagnosed with degenerative disc disease when I was 17. Here I am at 27 with L5/S1 90% degenerated, what's left of it is torn and herniated and L4/L5 is also herniated and starting to degenerate. The pain radiates down my left leg and more often than not, leaves me in bed, in tears. I have done physical therapy, traction, epidurals, medial nerve blocks, OTC meds, narcotic and non-narcotic pain meds. I have exhausted all of my non-surgical options according to my spine and pain management doctor. He referred me to a neurosurgeon who suggested a fusion at L5/S1. Great, surgery was scheduled in June 2015 for September 2015. My insurance company waited until 2 days before the surgery to call and say they were denying it because it was deemed "not medically necessary". The decision was appealed and after a peer to peer review of the case, was still denied. At the end of September I went to see a different surgeon, to get another opinion for the insurance company. He told me that there was "no way in hell" he would do a fusion on me when I could benefit from a much simpler procedure of a disc replacement. I was elated. This surgery was 45 minutes as opposed to 4 hours, 4-6 weeks off work as opposed to 12-16, the chances of me needing surgery again later in life are pretty much cut in half compared to the fusion. So, we scheduled the disc replacement. It was submitted to my insurance company on December 9. They literally did nothing with the request, didn't even put it into their system until one month later. Here we are less than a week to the scheduled date of surgery and they are denying this procedure because they "don't pay for spine surgery when you have degenerative disc disease".

I am in danger of losing my job because of the number of times I have been forced to call in because of the pain (even with a doctors note it gets counted against you). I feel completely helpless, totally screwed by my insurance company, and I am losing my mind. Recently, I've started experiencing anxiety attacks because of the amount of pain and stress I feel on a regular basis. I do not know what else to do.


  • LizLiz Posts: 7,832
    Please take the time to read this post and refer to it when you have questions

    I am sure that you will find your time on Spine-Health very rewarding. This site is a powerful and integrated system that is dynamic and growing.
    Here are just some of the highlights that are available as tabs on the main Spine-Health menu bar

    Spine-Health Main Menu Tabs

    Conditions Detailed medical libraries of articles and videos that address almost every spinal condition.
    Treatment List of treatments to the conditions identified by Spine-Health.
    Wellness Section contains articles, tips and videos to help patients after surgery and also to help people avoid surgery.
    Medical Articles
    Pain Forums These are the forums you will be using
    Find A Doctor This provides with a method to search for doctors in various locations.
    Videos Index to all Spine-Health Videos

    As a bonus, Spine-Health provides these patient forums. Here you can meet thousands of people who understand and can relate to your situation. You will soon become part of the Spiney family[/u] who provide comfort and the advantages of a support system. You are now part of this family that is approximately 27,00 international members and growing daily.


    - It is very important to understand the Forum Rules to make sure all of your posts[u] do not violate any of the rules.[/u]

    - All new members must read our FAQ in order to understand the layout of the forums, how to navigate through the forums, helpful terms, how to make effective threads and posts, plus a link index to many of the important medical forums and key medical articles on Spine-Health Forum FAQ

    I am positive any member, new or old will find this Chroinc Pain - Step by Step thread very valuable.

    Here are some links that all new members need to review to create effective threads and more

    Read before you post
    More Info Tips for Newcomers
    Understanding the rules

    All of this will help make your threads better and improve the times and quality of responses you will receive.

    You can also find Spine-Health on these Social Networks

    Facebook www.facebook.com/spinehealth
    Pinterest http://pinterest.com/spinehealth/boards/
    Twitter https://twitter.com/SpineHealth

    If you have any questions or need assistance, you can use the private message facility to[u] contact any one of the Spine-Health Moderators




    Liz, Spine-health Moderator

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    edited 01/16/2016 - 10:43 AM
    I totally remember this frustration when I was younger! Usually I can say something which sides with the insurance company or the doctors so they can come off as seeming less greedy but no. When I was 27 there were far fewer options for back health but yes, I did all the physical therapy, non-invasive treatments and all I experienced every day was extreme pain. And I got into a really deep depression and that intensified the pain. Then everything was blamed on depression. But none of this makes you feel less pain. I'd definitely offer to scream in frustration with you because sometimes that helps with mood issues.

    I'm so very sorry you;re going through this. Please keep writing. We understand the pain and hopefully we can help you find some options that help.
    I'll be listening,

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
Sign In or Register to comment.