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Diagnostic Tests, Results, Medical coding

dilaurodilauro ConnecticutPosts: 9,842
Ok, I am in the later part of a flare up. You all know that I have said when a flare up lasts more than 3 weeks, its time to see a doctor. I did, they did X-rays and such, and came up with the diagnosis: Acute Bursitis of the Hip Joint

Thing is, I know this doctor very well, and as my wife and I were talking with him, he was going through the various ICD-10 diagnostic codes. The way insurance works today, your problem needs to fit into one of those codes. It is beneficial to both parties. The doctor's practice will get reimbursed and as the patient, you should get the necessary treatments without additional screening.

Problem is, my problem is beyond what the ICD-10 codes allow. The doctor knows it, but unfortunately, he can not do anything about that. He did go beyond the guidelines and prescribed a medrol pack that may help ( really didnt it)

In reality, 10 years ago, based on my clinical examinations, additional actions could have been put in place for me. But today, its impossible, unless I fit into one of those codes, the doctor is very limited. Sure, he can go and provide all sorts of treatments, but when the insurance company reviews it, they decide if its going to be approved or not.

Its frustrating for everyone. I can not get what I probably could use, the doctor can not prescribe what he believe should be done.

I do know right now, one of our better more educated member, Itsautonomic, (Aaron) will add some of his views on this. Anyone who has been dealing with this for years understands the ins/outs the problems, the good and the bad.

Meanwhile, I am having trouble walking using ice every nigth tens unit 3x day and nothing is really helping (at this point). I do know that in time, this will pass, as all flare ups do, but geez, I would love to have these flare ups go away quicker.

Sorry, for my rant... I guess I can get negative as all of us can at times.
Ron DiLauro Spine-Health System Administrator
I am not a medical professional. I comment on personal experiences
You can email me at: rdilauro@veritashealth.com


  • When I had acute bursitis in both hips, they have me injections of lidocaine and steroids , and in a few days, the flare ups were easing.
    I don't know if oral steroids would work as well, but I hope they do.
    Bursitis is horrid.

  • SavageSavage United StatesPosts: 5,427
    ...for quite a while without relief!

    All these weeks of going through it must be quite exhausting...to say the least.
    Your entire well being suffering the wearing out kind of feeling from that relentless pain.
    I know the feeling of how it can be overwhelming.
    And now, added to that, the frustration of the ...ever changing,... "system" and waiting for the care you need...

    Anyone's spirits could suffer and brought down somewhat during this time.

    The insurance approval type process, at times, seems a little inhumane to me.
    As if they're forgetting there is a suffering human being on the other side of these codes..numbers...the black and white of it...the looking at a book to decide and stamp "approved" or "denied".

    Sometimes I think of it as if there is not even a person on the insurance end of things.
    Maybe one, to feed the codes into computer, and then waits to read computer's decision.

    I certainly hope your pain calms down quickly!
    And that somehow ... a code is found to allow you the treatment doctor wants to order.

    Spine-Health Moderator
    Please read my medical history at: Medical History

  • itsautonomicitsautonomic LouisianaPosts: 1,806
    edited 01/19/2016 - 5:56 AM
    Dilauro, over the last 4 years dealing with insurance to have special treatments or see specialist I have come to realize that insurance companies not only cost the patient a great deal of money, but they shoot themselves in the foot. The ropes you have to jump to meet their demands cost a ton for both parties, when many times it is know what is needed and could save the patient and the insurer money. The faster you get the right treatment the faster you get better and cost them less. I costed insurance a fortune and myself in my search , because drs often had to follow protocol they themselves did not belive would reveal my source of pain. A check the box if you will.

    Now that I have the right diagnosis, the right team used to fighting with insurance and a big name behind them hospital wise, I dont spend close to what I used to when searching and checking the boxes.

    How can an insurance deny people what is needed yet allow 6 nerve conduction studies over a 3 year period for me , or allow each new doctor to re-image my spine at their hospital in same place over and over again within short time periods? Some of it was neccessary , but most of it seemed foolish and wasteful to me. I am confused as the rest and I think its counter productive for insurance companies, but I guess they crunched the numbers and it works for them to continue this. I wish I understood it more on the insurance side, but I am afraid it will get worse over time as you said.

    I buy the most expensive insurance I could get , I could not imagine those not so lucky to have at least a top insurance. It allows some freedom in the plan with referrals and other things to avoid some of the middle men ( drs) and get right to the heart of my issues.

    The saddest stories I have heard were the ones where someone had all these symptoms, yet had to follow the insurance protocol that denied MRI and once they finally did get MRI approved it showed severe nerve compression or spinal cord compression that required surgury. You wonder what might have been done if found right away and how it affected their long term healing. But I understand that is the minority and pushing the MRI often works as the issue heals up with no need for MRI. I think its a broken system, but one I don't know if can ever be fixed.

    Sorry you are dealing with this, I know my mom has good luck with aspiration of the bursitis in her shoulder with needle and like sandi said meds injected, but this may be the treatment that you are hoping insurance approves. Luckily for her the doctor she is with somehow is able to get past the normal start them off waiting to see if passes and then with steroid packs, then therapy etc. She has done the aspiration several times and then is done for years, before coming back so he knew after first time the other modalities were just delaying the treatment that was proven to work. Some doctors know how to play the game to and can skirt the insurance system for what is best for the patient, don't know how they do it.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • itsautonomicitsautonomic LouisianaPosts: 1,806
    edited 01/19/2016 - 6:02 AM
    Yea Savage sadly I forget it is a business sometimes and stockholders and bottom line are what is most important to a business. But I feel it could be such a more efficient business all the while getting people the help they need.
    So many things are confusing to me when money is involved, I know working side by side with the goverment workers when I was doing road construction that if they got 100 million dollar budget, they were not rewarded if they only spent 60 million , their budget was then cut for the next year so they found uneccessary things to spend money on, redoing roads that had been recently done. That is off subject , but with money involved you wonder why things work the way they do in a way that seems counter productive as I feel insurance companies do.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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