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Insurance fun

In a little bit, I will be heading out for my C5-6 fusion, a day late and a frustration short.

I just wanted to share the fun I had this past week. It might be instructional, it might just leave you shaking your head.

Wednesday, five days out from originally scheduled surgery, I found out : a. I had missed my dental cleaning, b. my hair cut was on the book wrong at the place, and worse, c. the insurance had denied my pre-authorization pending further info. The neurosurgeon's office said they needed to send more details about the PT I had tried (they said I hadn't done enough, but I went to my appointments until the therapist said I shouldn't bother continuing, wasn't making enough progress and should save my money), and that the insurance wanted me to be cleared for surgery by my primary care provider for the tiny nodule that was found on MRI - that none of the doctors consider an issue and that was not palpable.

So I called my pcp and they faxed the letter to my ns who sent it to the insurance.

Monday morning (my surgery had been bumped from arrival at 6 to arrival at 11 to make time for approval) we found out that they didn't approve yet because the pcp had *personally* handwritten the letter, rather than have it typed by her assistant. And that just wasn't good enough.

The pcp office did get a typed version out, but not in time to have surgery that day. So it was going to be either today (Tuesday) or next week on Monday, depending on when approval happened. It happened at 4pm, so Tuesday it is. Phew! (I am mentally prepared, and didn't want to have to wait another week!)

Full speed ahead, Mr. Sulu!

I hope to be back and sharing how helpful it was... :D



  • You gotta love insurance companies and Drs. Before my last surgery the Nero I was seeing laid it out on the table what all they where going to do with pt injections all that. Well I do pt get the injections. ..... he turns around says o we have to start all over again insurance won't let me do anything yet even though it hasn't helped. I call insurance fuming mad insurance says the Dr hasn't contacted them for anything needless to say I was not happy and all that. After all said and done the Dr did say he really didn't want to do surgery on me so I moved on because I didn't feel like paying out the back side for injections that didn't work. Fast forward to may of last year. I find a Dr sit down with him go over everything he does a exam looks at all my charts MRI x-rays all that flat out says this is what I think it is this is what I can do. So I scheduled the surgery got everything pre authorized have the surgery all good until I get a letter from the insurance company stating the surgery center and implants they used weren't covered and I may be liable for $17,000 in cost. It's still pending to this day.
  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    Good luck LeaRN! We will be thinking about you & giving you positive thought!
    Give us an update when you are able.
  • Everything went smoothly - my dh told me the doctor said it was "boring" - which, of course, in this case is a good thing!

    My sternum hurts a bit (where the graft came from) and my right shoulder is a bear, preventing sleeping so far. I just took a stronger pain med (Percocet - never had it before) hoping that will do more for it than Norco did. Just gave me one, since I was starting to get a bit nauseated (I'm one of those who would never be a good drug addict! The "good" stuff always does that to me.) she gave me an anti-nausea first, so that should help.

    Home tomorrow!

    I wish everyone who has this done has as relatively easy a time of it as I have, and as nice a place to have it done. Everyone is so nice. Sleep would be nicer, of course, but I am hoping for that tonight. :-)

    Thanks for asking, Motor1.
  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    edited 02/03/2016 - 5:42 AM
    It sounds like everything went well. Be sure to keep up with your pain meds & don't let the pain get ahead of you.
    Also, listen closely to your discharge instructions.
    I hope your transition to home is a smooth one!
    Take it easy.
  • Almost a week out, (would have been if insurance.... Ah, well!) and I seem to be doing well. Slept great last night. Ahhh.

    Pain meds and I continue our love/hate relationship. Not sure if it was that that caused me to lose my pizza yesterday, or if I just wasn't ready for it, bit I no longer have a desire for it! 

    The he only pain remains the neck and shoulder, not where it was operated on. It is so weird, as I really intellectually feel like it should be near the incisions. I will take it, though. I will also take soma (muscle relaxant) and maybe anti-nausea and pain meds. I really hate those suckers. :-)

    I continue to be a member of the"least likely to become a drug addict" guild. :-)

  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    Make sure you don't take your pain meds on an empty stomach. 
    I'm glad to hear you continue to do well. 
    There are many people on here that say their shoulders are sore after their surgery. I was one of them, but my pain ended up being a torn rotator cuff. Your soreness could be from the position they had you in while doing the surgery? 
  • Yeah - I actually initially went to the shoulder doc, sure I had shoulder problems again. Nope.
    I do think the position they had me in is part of it. I am glad to be able to say, the morning (worst time, shortly after getting up) pain is no longer what I would call "screaming pain" and now much quieter. Still there, but other areas are popping up as more sore now, which may be just because the other pain is quieter.

    I bumped up my walking around the house yesterday and hit 10,000 steps. So I think I will continue to make that my goal each day. :-)

  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    I'm glad to hear your shoulder is feeling a little better! 
    Walking is my only form of exercise right now, too. I live in the north east & unfortunately, we are in a big artic blast of cold air right now. It's 2* and the windchill is -10. I'll be joining you in walking around the inside of the house. 
  • Okay, on the off chance anyone is looking because they are going to be having this surgery, I will continue posting my recovery. I'm 2.5 weeks out, had my follow-up appointment earlier this week (2 weeks and a day), and because I'm walking a lot (over 10,000 steps a day, based on my Fitbit), I can ditch the compression stockings. (Yay! I hate those suckers.) I also was told I don't need to use the neck brace any more. Yay! I am more comfortable without it. In fact, he said that I don't have to worry about moving wrong, that at this point, I won't do any damage to myself.

    He also is sending me to PT (I still have a lot of shoulder/arm pain) and said no housework, laundry, etc. (DH was there, and I think he was said, in a somewhat exaggerated manner, for humor and dh's benefit. But definitely no vacuuming yet.)  I asked about easing back into running, and he said to give it another 4 weeks. So I have that to look forward to.

    I go back in a couple weeks for an x-ray and another follow. Get to see how the hardware is sitting in there. (I asked about that and security screening, and he said if I go somewhere warm, I need to take him. Lol. I really appreciate doctors with a sense of humor!)

  • I'm healing well - hard to believe I'm a month out already! - and driving. I occasionally take "stronger" stuff before bed (I hate narcotics; they make me so nauseated), but mostly am just taking either Tylenol or nothing. Tylenol does little, so I often don't bother.

    My initial MRI (back in November) showed a hemangioma on my T1 vertebrae, and he wanted to do a repeat MRI after a few months. Wednesday, I saw him again, and asked him if he still wanted the repeat MRI. He flipped through my chart to refresh himself on why he wanted it, and said yes, he did.

    Had that done that day - they happened to have an open slot (will wonders ever cease?) I didn't expect to hear back and just be told everything looked fine on my next appointment in 6 weeks. But nope, got a call today, and he now wants to correlate the results with a CT scan. So as soon as insurance authorizes that and I get that appointment scheduled, I will call for a follow up with the NS to review that.

    I hate waiting and not knowing much of what is going on! Uncertainty drives me nuts. (Which, of course, means life does. :D) But, I will have to be a good little patient and just go to PT for now, and try not to think about it too much.

    I hope all are doing well.
  • In case anyone is facing a cervical fusion and reads this and wants to know what life is like 3 months out, in a word, good.

    I can't say ALL the pain is gone yet, but since I've read that it can take up to a year, I will give it time. But I am well fused, my arm pain is gone, most of my shoulder pain is gone, and I'm down to occasional PT (he wanted to see how I would do on my own, I ended up back, and he is now trying 2 weeks before my next appointment.)

    So all in all, I would say I am glad I had this done.

    As an added bonus, I was able to ask my neurosurgeon for a second opinion at my last post op, and he correctly diagnosed me for another condition that the neurologist had misdiagnosed. So I am getting proper treatment for that. (Or working on a solution, I guess, as what we are currently trying, increased dose of meds, isn't helping.)

    All because I had a sore shoulder last August. Sometimes things really do work out.
  • SavageSavage United StatesPosts: 5,427
    Hello LeaRn.....
    Thanks so much for the update! It's very good to hear how well you are doing!

    Good luck with your newly correctly diagnosed condition....and your continued post op recovery!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • kd1kkd1 MassachusettsPosts: 19
    Thanks for the updates.  This is helpful. I am going in for a 2-level ACDF C5-7 June 7th and hearing positive outcomes is reassuring.
  • SavageSavage United StatesPosts: 5,427
    Hello kd1 ! You may also want to check out the Surgical Buddies thread for June, 2016....
    many people sharing similar situations at same time for encouragement, and support....
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • kd1kkd1 MassachusettsPosts: 19
    I've already posted there, thanks!
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