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  • charry said:
    They can't turn down so many Drs? Take care. Charry
    5 years ago I had 2 OS, 1 NS, 1 chiropractor, my PCP, my PM doc and a reconstructive plastic surgeon all who documented in writing that a breast reduction would decrease my mid back and shoulder pain significantly. I was denied on 3 levels of appeals. Pretty much told, that their doctor, who never even saw me, says they are all wrong. Insurance companies can get away with so much. The damage to those discs could have been slowed down with that surgery. Now I can look forward to those discs continuing to deteriorate. I allready had 1 shoulder surgery and looking forward to more. OK enough venting, sorry.

  • I love your last line of your signature. I feel ya there. I get 90 percocets every 8 to 9 days. I also take Valium, but thankfully right now that's it. I used to be on Dilaudid as well, Flexeril, and a few others.
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  • I missed it, (I may have) yo never say why you failed to meet the criteria?
    Can you challenge that?

    Perhaps you can suggest a case that discusses even more expense to the insurance company long term if they deny you prompt treatment?

    I am in UK. Here patients are usually left for a year trying other methods of pain control before surgery is done, unless it would be stupid to sit and wait for clinical reasons.
    I am not sure where you would sit if you were to live here...perhaps that may help you see rationale of the insurance company??
    I don't know - is it the same? will you have to suffer a year to prve worthy of surgery?
    Good Luck.
  • Good luck to you on your Surgery, my injury is also work--related,i got hurt jan 2004 went to Chrio for over 2 years had every injection.. was placed in a lite duty position, re-injured my self in july 06, my foot got caught in the reil road track, boom my left side hit a beam i went dowm!! had to have surgery nov 21 06,(could hardly walk).went back to work 3 months later sooo stupid, started seeing a pain Specialist in Dec 07,being in lite duty they can place you where ever and whenever,,, In March 08. doctor took me off work.. di every test whatsoever, now all my test r positive i am waiting for approval for Reconstructive Surgery,, i have to do this all over again and since the doc left the bone out do not understand a now the rods r un-even, also they have to go a level higher the pain is bad,, going to work comp doc so he can read my MRI again. i do everyhthing they ask and they keep wanting mor i just want to do the surgery . and go on with my life,,I hope all goes well with you and so sure it will i hope you got a terrific surgeon, this time i got 3 opin smarter this time and in no hurry to get back to work!!, take your time your job will be there dont be boo boo the fool like me iam so suffering now!! good luck to you
  • I was scheduled for surgery on 11/5 and the day before I received a call from the NS stating it was denied for the same reason. I am on my 3rd appeal and will no something on 12/5. I asked my insurance company if I can't have the surgery than give me another option. I have tried all non surgical forms. I think they want you to be half dead before they approve anything
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  • I'm sorry to hear you were denied that surgery. I often wonder if I need one also at 44DDD. I think the weight is alot on my back. Take care and wish you the best. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Thank you to all who responded! I unfortunately haven't heard anything back since the last MRI and since they have resubmitted the claim. Please let me know how your third appeal goes. What insurance co. do you have? Just curious if it is the same one as mine. What surgery were you to have? Hope everything works out ok for you....I wish you well. You all have been so great...I love getting ideas on what to do so I can at least feel as though I'm in control of something...because I feel so powerless right now. I hate that the insurance companies have so much power over our bodies. This is totally out of control! ~X(
  • I've been getting the run around from me WC claim. worse my company is self insured. however my lawyer has sped things up to say the least. they're still fighting on my wages but we'll see. if anyone needs a good WC lawyer in Vegas or Reno PM or email me. MINE ROCKS!!!! hope things work themselves out. hang in there. we're here to prop you up :-) >:D<
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