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Hi all I’m new here. Yes I have a big problem.Early October I had a fall that whiplashed my neck. I really did not think it did anything. A few days later my daughters boyfriend and I were putting a gun safe in our basement. We were using a moving dolly. While lowering it down the stairs I felt a pull in my shoulder and neck. Dam that hurt. Later it was aching so I iced it . Days after it was getting worse. As soon a I dropped my arm pain radiated down it along with pins and needle sensation. To get to the real deal of this story. I was diagnosed with two significant herniated disc at C5C6 and C6C7. I went through the invasive protocol path which was pain meds, muscle relaxer, physical therapy, and one epidural injection. Nothing helped and my condition worsened. My strength in my left arm diminished by 30%. Muscle density has decreased in my forearm,tricep,bicep and left pectoral muscle. Hand coordination is compromised along with tremors. On Dec 5th, My orthopedic spine doctor recommended a two level artificial disc replacement with mobi C. I agreed with my doctor . I had to get approvals from my primary physician , cardiologist, and get an ekg and blood work. Though all approved that I was not a risk , it was a pain in the hello to get their office to submit their approval to my orthopedic doctor. So start on Dec16th per pre op instructions I stopped take the pain meds and muscle relaxers. Also had to wash the bed sheets two night before and shower with a special soap. I followed very thing . Now the fun part. Dec 19th I had the pre op conversation with the hospital surgery nurse to collect my medical history. By 11am I receive a phone call from my orthopedic doctors office. I was told that the pre certiction doctor denied the ADR and would only approve a fusion. I currently have full mobility of my neck . Getting a fusion is obviously going to mess me up especially being as active as I am. Fusion apparently requires following surgeries since it degrades the disc above and below the fused disc. This doctor is in Arizona whereas I’m near Chicago. The reviewing doctor is a internal medicine/ occupational physician over 60 yrs of age. Huh?Thats like having a proctologist’ to review a cardiac procedure. Man ...Aetna is messed up. This doctor first states that the ADR is an experimental procedure that is not covered in my policy. Well I checked the policy and it is accepted. Funny back in 2011 fusion was noted as an experimental procedure that they would not cover. Seems like its all about the money. Doctors denies the higher dollar procedure and they get a bonus.. Well this get better. My doctor requested a peer to peer meeting to discuss my case. This time Aetna representing doctor in California was an orthopedic doctor who specializes in hand , elbow, arm and shoulder. What no spine experience? Hell the should just hire a call center over seas and have someone with no experience read policies and make recommendations. This is horrible. Well it was denied again and surgery was scheduled for today dec27th. My doctor is appealing again and next surgery date is dec Dec 31st. Yup New Year’s Eve . How many doctors under Aetna umbrella are going to be available to review it this holiday timeframe. I’m throwing the option of cashing in some investments and paying out of pocket to resolve this . Then hire a lawyer and file suit for bad faith. That will obviously cost Aetna a lot more than the ADR procedure. I’m going to see my doctor tomorrow to go over all what’s happened and the path forward. To add to all this I usually get 3-4 hours of broke up sleep hours per night and I have been off the pain meds and muscle relaxers since Dec16 th. That a long frickin time when my pain levels are at 5 for the low and peak to 8 at its worst time. So I guess I could add pain , suffering, stress depression to the suit. Aetna is horrible. Oh I have 5he high deductible plan too. I m close to meeting the whole family deductible of $6K.
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