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Anybody had their insurance deny surgery?



  • After being on this site for so long. I have found ALOT of insurance companys will not pay for the artifical disk.
    Stenosis is painful I only know that by hearing the other pts in my ortho's office when I go there. He usually tells them after PT if nothing helps surgery is the only option.

    Mabye its the way the letter was written to the insurance company?? Not sure as I have never had this issue, but I know if its worded the wrong way just a little BANG.

    Just keep going, keep fighting the issue!!!
    This is what my insurance company requires from the Drs office before any surgery:
    Type of surgery.
    Reason for surgery.
    What will happen to the pt if the surgery is not performed.

    Also really try having the drs office submit it as having a fusion with your own bone instead of the ADR.
    May make a huge difference in their response.

    I wish you the best of luck!!!!!
    Terri O:) O:) O:)
  • That could be the reason, although they don't want to admit it. I am going to try to go as far as I can to get this paid for, because I have a lot of confidence in my surgeon and I want him to do it. But if I can't, then I think I will try to get a more "regular" fusion done - maybe they will be more inclined to pay for that. Anything has got to be better than this pain I am living with day in and out. I just hope they did not set a precident by refusing the first one, thereby having to refuse the second as well... oye! 8} :<
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  • My insurance company denied artificial disc replacement. I too apealed all the way to New York state insurance dept then finally went with fusion which they did pay for. I wish you the best of luck. It is difficult dealing with insurance approval on top of all the pain you are experiencing.
  • Did they do like a compromise or what? :/ Did they flat out refuse the ADR and then offer to do the fusion instead? How are you doing now? Thank you for your reply!
  • Thanks for the PM heads up to let me know you had more questions. I appreciate that since I check my pm's more than topics i've posted.

    My doc pretty much new the adr would be refused since my insurance has yet to approve it due to experimental/investigational however, he knew they would approve the fusion due to past experience with patients that have same insurance.

    I don't know if it would've made much of a difference which surgery I had in the short term. I think I would still be feeling like this. What I mean by "like this" is that I am still having a lot of nerve pain. I don't know if it's just because my nerves are healing from everything and I just need to give it time or if it's permanent nerve damage. I am going to a neurologist and have nerve tests done at the end of this month to find out. My ortho surgeon told me in the long run, a fusion usually puts strain on your health discs above or below fusion, therefore 5-15 yrs down the road, I may need another fusion or surgery at L4-L5. It all depends on how my discs responds to this fusion.

    I wish the best of luck and you really should talk to you surgeon about alternatives in case your insurance does not approve this. In my case the insurance company did not offer and alternative. They just refused the surgery requested and then the surgeon put in for approval for the fusion and that was approved immediately. I also have over 6yrs of documentation that I've tried all kinds of conservative methods that did not work for me. Everyone is different though and responds differently to treatment so I hope that I did not discourage you in anyway.

    Good luck with your insurance and please keep us posted on your progress.
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