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Don't know what to do....Appreciate any help

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:29 AM in Health Insurance Issues
Hi all! I am a first time visitor to this site and to these forums. I apologize if my understanding about my issues or how the forums work is less then stellar. Where do I begin?

Well, I injured my back lifting weights when I was 15. After 6 months of the injury I finally had an MRI done. I was shown and told that I had 3 Bulging discs in my lower lumber. Worst disc was my L5-S1. I was told that being so young there was a good chance of my body healing on its own. Well, that was never the case...for the most part.

For about 12 years I was dealing with semi chronic back pain. It was much worse the year after the injury, but got some what manageable as time went on. I was never the same, or no where near what my health was before the injury. Fast forward to last year...

I guess I can say I threw out my back last winter? I couldn't stand up, was in immense pain and had what I would say was the feeling my spine was but a thin bone connected to a cracked set of hips. Being that, It felt like if I tried to move or stand up my back was gonna snap in two. From that point on, my back got worse.

I knew and told every single person around me that there was a very good chance I would need surgery. So, being the person I am. I prepared my store (I was a retail store manager) for the probability of me being out for what I thought would be only a few months while I had surgery. I lined everything up for a successful and speedy return as to cement my position while I was away. Being that I didn't want *MY* store to suffer because I was suffering...

So, in the end of september I started seeing a pain specialist. We started off with PT, then pain medication..when those had no effect and my health seemed to get worse we had an MRI which showed that I had a Degenerative disc with an HIZ (High Impact Zone/tear) in my L5-S1. After the diagnosis we tried a Facet Block, when that had no effect I underwent a Discogram. It was the worst pain I've ever felt in my entire life. After the discogram we had a CT scan taken. Which showed the tear in my L5-S1. At that point I was referred to a Spine surgeon and told that most likely I would be looking at a fusion, but I would have to wait till I spoke with the surgeon to be sure.

I meet with the surgeon, and by this time I've been out of work since Dec 20th. My Short term disability had been in effect now for 1 month, and I am allotted 3 months of STD. That's where everything went down hill, and fast. The surgeon said that I would be a candidate for spinal fusion and said I could also get a second opinion. Being the quick acting person that I am, I said "I trust you, let's get this done so I can go back to my normal life" He said, O.k. if that is what you want we will schedule the surgery. It should take only 2-4 weeks to have it done.

Then the stress kicks in. It takes 2 months to get the surgery scheduled, being the Doctors office has neglected to process my paper work promptly three times I was in jeaporday of either losing my job,losing STD and losing Insurance. I actually had my STD suspended for two months while my company and company's insurance was waiting to hear back from my doctors office on the paperwork they needed for processing my claim. Then a month into my wait I get a call saying my surgery will have to be postponed by one week. I'm thinking, I'm gonna be past my STD by the time I even have the surgery, so when in the heck will I even be able to return to work?

Fast forward a bit, I find out because I've been gone from work for so long I've lost my position as store manager. Wow. I still haven't even had surgery. What on earth am I going to do about money? I worked harder then most people in my field to go out of my way to help others and be the best at my job. I stood out from my peers and was proud of it, and I have no job even though I excelled at what I did and was recognized for my achievements.

Fast forward to the day before my scheduled surgery April 2nd. I get a call from the doctors office saying they still haven't heard back from my Insurance as to whether or not they will authorize the surgery. I call the insurance company and find out that my doctors office waited till March 24th to send in said paper work, where I was told that that was not suitable enough time for review of those documents. That there was a high chance it won't be approved by the 3rd of april, my surgery date.

I called the doctors office and they tell me it's a courtesy for them to even send in that paper work and that most offices make the patients do that. Well, that's all fine and dandy. But that kind of information would've been useful 2 months ago when I first agreed to the appointment.

April 3rd day of surgery I get a call saying that they've not heard from the insurance company as to whether or not it will be approved and that my surgery is cancelled and will need to be rescheduled. But I could not be told whether or not I would again have to wait another two months or longer to get in for surgery?

I am absolutely dumbfounded, destraut, furious and above all else in severe pain. I have had my life in the hands of people who literally do not have my best interests at heart or my health. I called another practice and go in on Monday for a consultation with another surgeon.

What I would love to know from this community is simply, what do I need to know? I assumed that since this was there job and what they do every day they go to work, that these problems would not occur and that since I've never had surgery in my life and since I have no idea what to do to prepare as far as paper work, phone calls needed to be made, financial arrangements and every other issue underneath the sun I feel like my life is over. I really truly am depressed.

Financially what do I do? I'm looking at selling things, but that still is not a source of income. I'm paying insurance premiums out of pocket while I have no STD. When does that run out? Between getting surgery scheduled and who knows how long recovery will take it will be close to a year if not longer till I can work anywhere. What do people in these situations do to survive? Please, I'm begging for guidance.

I am truly sorry that this is sooo long, and I'm pouring out everything. But I truly thought this is how it works. No sense in stressing or over reacting because these are professionals and this must be what everyone goes through and then it all just works out. So I never questioned anything, I said Yes and O.k. and That's fine! What do I get for my complete and utter compliance? Stress, loss, let downs, confusion and all else still severe pain. Please if there are any links you can suggest I will read them front to back. Any help, I swear I truly appreciate!



  • I am glad you are seeing another surgeon, because anyone who has office staff that is that incompetent, makes me wonder how good of a surgeon and his after care would be. When I have had surgeries the staff has always taken care of all paperwork.
    I don't know what to say about your financial situation. See what this surgeon has to say and then take one step at a time. Things have a way of working out if you have trust.
    Good luck.
  • Welcome to spine health.
    No your story was not to long. No ones ever is. You explained it in depth.

    So sorry all of this happened to you. I really do not have any guidence for you except your already in the right direction as in seeing another surgeon.
    I know with all my surgeries, this is how it works:
    The dr records his notes.
    The notes (tapes)then get sent out around the world for dictation.
    Then the notes have to be sent back to the drs office.
    Then they get sent to the insurance companies for approval.

    Now we all now all insurance companies have their own policies in how they run things etc.
    In most cases that should only take a week or less. Sometimes it can take longer depending on when those medical notes get back to the office and get sent back out again.

    See if you can get any type of help/assistance from any programs around your area.

    Its hard to put the blame on one person.
    Seems like you went through a full exam process before they decided to jump on surgery. I'v known some drs to say well surgery is all there is.
    I mean you had the discogram , the whole package. So to me that was great on the drs part.

    Keep us up to date on how your making out.
    Alot of people have been where you are now.
    My last surgery in November I did not get approval till 4pm the day before surgery!!!!!! It was nuts.

    Take Care
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  • Everyone needs to vent, this is the perfect place to do it. I'm so sorry for all you've been through. That is not how it is supposed to work.

    I do understand your frustration. I work for a large retail pharmacy chain and although my manager and co workers have been nothing but supportive, dealing with the corporate office has been a nightmare.

    I went through all my conservative treatment with an orthopedic surgeon. His office was disorganized to say the least, and he and his staff (except for his assistant) were too busy and burned out to care about anything or anyone.

    They didn't file my paperwork for STD, even though I paid them to. When they finally did finish it, it was wrong! It had someone else's medical information on it under my name. Then after it was sent my corporate office said they never got it. It took two months (without pay) for the dr's office, insurance office, and my corporate office to finally get everything straightened out.

    When I ran out of conservative treatment, I was thankfully referred to a neurosurgeon. He is wonderful. He and all the staff go out of their way to help me. They file all my paperwork for no charge, they do what they say they will, when they say they will do it. My surgeon believes what I say and takes the time to answer my questions and explain what is happening.

    See what happens with the new doctor on Monday. If you are unhappy, MOVE ON. You don't have to accept poor medical care. There are good doctors out there, find one.

    As for your job, did your company approve your leave of absence? Did they offer you the opportunity to accept another position such as an assistant manager or supervisor? The FMLA and/or ADA is supposed to protect you from being fired for medical issues, see if either of these acts applies to your situation. Look into those and call your HR department to see if you have any other options. I would also suggest getting legal advice.

    Good luck, don't give up, and keep posting.
  • I am very sorry to hear about everything you have gone through. That is terrible!

    Do you have State Disability available to you? I have been on it since June of 2008 and it pays a good percentage of your regular salary. I don't know if this applies to all states but I am in California. I don't know what State you are in but I hope it is available to you.

    Good Luck!

  • It's rough you're going through this. Ask human resources for the record of employment. I had to live 15 weeks on government employment sick benefits. After that I started LTD. I cut cable went to lite speed internet and cut back everything. Looking for food banks but decided to use a line of credit. If you have a union they can help you. But also your humane resources can tell you what happens. I'm sorry you're going through all this. Good luck. 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
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  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    Sorry you're going through so much. The stress and depression only add to your physical pain. I hope you can soon get help. Take care and keep the faith.
  • Well, when speaking to some people about financial assistance or protection they have mentioned one or two things. One being contacting Health and Human Service for my state and the other food stamps. What can I expect from doing so, and are there other orginizations or programs to go through to seek advice? I will have been out over 6 months from work by the time I even get into surgery, where ever it is that I'll go. My short term disability pay was for only three months which I've already used up. So, now what?
  • Andrew,
    Go to the Governments Social Security site or call your local Social Security office tomorrow and apply for Social Security Supplemental Insurance. There is a thousand forms but basically when you are done if you don't have many assets they will provide you with income to help you live on...it's not much but it might help tide you through. Give it a try, can't hurt. www.socialsecurity.gov
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