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Denied Surgery

So I'm scheduled for surgery Tuesday the 20th my surgeon called me today saying my insurance denied me because I don't have enough therapy time in remind you I've done 24 weeks of therapy before having a MRI only to find out I have spondylolisthesis L5 pars fracture with scoliosis severe sciatic nerve pain where I can barely walk I ve had Injections done and my pain just got worst and when I talked to my health provider and ask to speak to a supervisor he had no answers and offer me to a pain clinic for medication which is contradictory because there s signs posted everywhere to avoid opioid addiction I got the complete run around my doctor called and said he s appealing it himself because he knows my condition and the pain in in this insurance company is a joke and I'm suffering I'm looking for legal action because why would you want me in therapy with a fracture back  causing nerve damage makes no sense at all I need answers ASAP.

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Comments

  • Unfortunately, there are very few conditions that warrant immediate surgery involving your spine.  Your best bet is to let your doctor continue with the appeal.  If that doesn't go well, lawyer up.  Some insurance companies will knuckle under if they know that they may face legal action/award against them.

    I know it's not comforting to hear, but WC required 6 months of conservative treatment before they would allow me to have surgery.  You are really close to that mark now.  I understand you are in pain, but don't give up! 

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • L4_L5LL4_L5 Posts: 1,480
    edited 03/17/2018 - 9:21 AM

    Unfortunately, there are very few conditions that warrant immediate surgery involving your spine.
    Some would argue fortunately is more applicable here!
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  • L4_L5 - I hear what you're saying, but when you are in pain and getting the run around, it's frustrating and can really lead to some depression.  The balancing act is finding who really needs surgery and who can probably wait.  Pain is so subjective.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I totally agree with you pain can depress a person a lot.

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