I am very frustrated and don't know where to turn. If anyone can help pleae let me know!
Here's the story...I started having pain in May 2008. I started going to a chiropractor which after about 4 weeks he sent me on to a NS. The NS started me on physcial therapy, then sent me on to pain management where I received 3 epidural injections over the next 3 months. After exhausting all of these with no help to my back the NS finally decided that I need to have an L4/5 TLIF. They ran it through insurance before scheduling where insurance denied the claim saying I didn't meet their "criteria" for surgery. The NS appealed this claim and then spoke to insurance doctors and still denied this claim. Yesterday 11/21/08 my NS sent me for another MRI to see if this would help in the appeal.
My NS is very upset that they would question his judgement after being a surgeon for 35 years. Obviously this isn't the first time this has happened but it never seems to make it any easier for him.
I'm in waiting mode to see what the insurance co. says about this 3rd appeal. Has anyone had experience with this if so...who did you contact in order to get something done? I am in SOOO much pain and am needing this ASAP.
Oh, and I forgot to mention...I really think the insurance co. is holding off til the first of the year because we are almost at our "out of pocket" expense cap for the year which means we would pay very minimal for this surgery. So I think the insurance co. is trying to make us hold off til the first of the year ~X(