..beside yourself!
I wonder if doc wrote up the order for your surgery in an odd way..that insur co read as "experimental".

Maybe doc can rewrite order in more accepting way.. i dunno.

I don't really know, but maybe getting most recent notes from you doc and re petitioning you insurance co.for able to have your surgery....maybe that would help approe surgery.

Maybe a second doc opinion???

Let us know how it works out for you!!

Have you tried all the usual methods before surgery will be scheduled? Physical therapy and injections? What is the doctor doing that the insurance company is saying experimental? Is he talking about using a artificial disc? There is something in his wording to the insurance company that is causing a determination of experimental. Collect all your medical records and appeal your claim with all records attached. If you need help with the appeal process Ill be more then happy to walk you thru it. Go to your insurance company web site and there should be a form for appealing. Ask for a expedited appeal due to the pain and suffering you are enduring due to the insurance company denial. Good luck
Susan

Do you have an HMO or a PPO policy? HMO's are far more restrictive. And many insurance companies are pushing back on approving spine surgery BUT if your doc is one of the best he and his insurance staff can try to navigate around that.

Do you have a Pain Management doctor? You mention hydrocodone but don't mention any long acting medications like Oxycontin ER, Kadian, Opana ER, MS Contin ER, etc.

seriously i would be rather hesitant having had 4 fusions and then go have another surgery, but that's just me. the research literature tends to point out that the more surgeries one has the more we open ourselves up to risks that are just not worth taking. i think much better pain control would be great for you. i also have had multiple surgeries and my doctor has said i am not a good candidate for more surgery (which i don't need now anyway). but even if i was in need i still might not be a good candidate. it has taken a while to get reasonable pain control. i have a lot of limitation and have had to give up many things, but since i am not rocking in a fetal position in the corner writhing in pain i am happy. my pain by no means is gone but i am able to function reasonably. i am only taking enough medication to keep me someonewhat cognizant. basically i have pain but only medicate it to the point where i can both function reasonable and cope with learning to live with chronic pain.

Put simply, my spine is a mess and I have had eight surgeries. While they have stablized the spine, the pain has does nothing but increase. I have two new ruptured discs and will not have anymore surgery. I am in a wheelchair now as I no longer safe even on a weight baring rollator. Medicaid will no longer authorized outpatient PT as they say it is no longer helpful. Medicare actually told me that I am not a good investment anymore. Good luck.

...a very rough way to be told you are no longer covered. That therapy no longer beneficial.

Is sometimes difficult to not have that absorbed into who we are as people. I hope you have strong support system who remind you regularly of your worth and who help you as you continue to navigate the system to get your pain relief.

Glad to see you share that info on this site and hope this site able to be support to you, also. I am glad you wrote about what Medicare said to you.
Those people need some help with people skills.

Hope this weekend is refreshing and pain tolerable for you. Take care!

TXLAdy,

As people have said appeal it. It sounds to me like there is a disconnect between what you think you are having for surgery and the code the dr is giving to the insurance co.

Call the Dr, and find out what they are reporting to the the insurance co. It could be a case where the Dr is reporting some new procedure that has not been around long. I have never heard a fusion is new, so keep digging, and I think it is a coding mistake. Good luck.