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Depressed,Need 2Level ALIF,Insurance will not pay!!!

brenda cannonbbrenda cannon Posts: 150
edited 06/11/2012 - 7:55 AM in Depression and Coping
Hello,how is everyone doing? I`ve been to my last NS...I`ve seen 5!!! They all agree. That is another big surprise!!! What is really sad, my insurance will not approve it!!! I won`t say which one.(that is against forum rules,right?) They all say it needs to be done sooner not later. The ALIF is the best option for the fusion. The surgeons, when they learned of my health insurance,all said, they won`t approve it til I`m using a walking!!! Number 1, who in their right mind wants a fusion? I don`t!!! My insurance premium is 1400.00 a month, and that is with a high deductable. I think I`d be happier with a health diagnose of a terminal death. At least, I`d know the pain would lead to a conclusion. A final countdown!!! For all you country fans,Live Life Like You Were Dying. Dang it, my body won`t let me do that. Take care all. Sorry this post was so depressing. I just needed to vent.
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1

Comments

  • Howdy Brenda,

    Sorry they are telling you this. I see part of this "refusal" as the fault of the surgeon or their staff. A lot can be "fixed" if the surgical request is worded correctly. Have all these surgeons told you this, or just this last one?

    I have Federal BCBS, and have had surgeons tell me "I can't get an MRI or multiple MRI's without pre-approval" which for my insurance is incorrect. So what I am getting at, until the refusal is written, and appeals also denied, I would keep pushing for the surgical approval.

    Almost forgot, you can call your insurance company and find out what the criteria is for your surgery as well. Then let your surgeon know, and maybe this will also help them in getting you approved...just my 2¢

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • LizLiz Posts: 8,835
    I am so sorry to hear you can't get your insurance to pay for your recommended fusion Brenda,I know how long we have been chatting about this so also know how long you have been waiting. It is upsetting after all this time that you still can't get it approved.
    Take care xx

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
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  • What is a walking #1? Is that like going to the bathroom #1 or #2? If the dr,s feel surgery is needed and the sooner the beter and insurance wont aprove it sounds like a lawsuit in my opinion against the insurance company. First of all what is there reason for not aproving it? You said you have to use walking number 1 whatever that means. If that means a walker then ask for a walker and now they dont have a reason to deny it.

    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hey ya`ll... Thank you all for your kindness and taking the time to respond to my post. I`m in the process of doing everything to get all my stuff prepared. I`m really sorry for sounding so desperate! When I mentioned a walker,the last 3 surgeons expressed that Anthem Mo., literally were almost impossible to get Lumbar Fusions approved!!! They said(not my words)it seemed like they wanted the patient to be disabled, and in such bad shape,they needed a walker!!! I`m just feeling really sorry for myself and depressed!!! I hate feeling this way. I know there are so many more people in worse conditions and dealing with worse pain than I am. As everyone knows dealing with any ongoing pain,never being able to do normal things is so depressing. Life gaves us so many lemonds, it gets really hard to make lemonade!!! I feel so bad for my family, they have a hard time knowing or understanding why I`ll never be the person I once was,Surgery or not! That`s just the way it is. I am so thankful for the people who made this websit. Whatever anyone is going through something,SH is here. Everyone I`ve had the blessing of knowing or reading their post,chatting in the SH Chat, I think the world of all of you! I wish I could gave all of you big hugs! Brenda
  • Hey ya`ll... Thank you all for your kindness and taking the time to respond to my post. I`m in the process of doing everything to get all my stuff prepared. I`m really sorry for sounding so desperate! When I mentioned a walker,the last 3 surgeons expressed that Anthem Mo., literally were almost impossible to get Lumbar Fusions approved!!! They said(not my words)it seemed like they wanted the patient to be disabled, and in such bad shape,they needed a walker!!! I`m just feeling really sorry for myself and depressed!!! I hate feeling this way. I know there are so many more people in worse conditions and dealing with worse pain than I am. As everyone knows dealing with any ongoing pain,never being able to do normal things is so depressing. Life gaves us so many lemonds, it gets really hard to make lemonade!!! I feel so bad for my family, they have a hard time knowing or understanding why I`ll never be the person I once was,Surgery or not! That`s just the way it is. I am so thankful for the people who made this websit. Whatever anyone is going through something,SH is here. Everyone I`ve had the blessing of knowing or reading their post,chatting in the SH Chat, I think the world of all of you! I wish I could gave all of you big hugs! Brenda
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  • Well if they want you to have a walker get your doc to give you a walker!! You can also try to threaten them with a lawsuit for permanent damage because they delayed your surgery. If your doctors will write something to this effect they may change their minds. Remember the squeeky wheel gets the oil so start squeeking!!
  • Great idea!!!...I`m getting that wheel oiled!...Thank you Kris, you made me smile. I didn`t know I could smile while crying! I`m sending you gentle Hugs!!! I will always love my friends in SH! You guy`s rock!!!
  • Like Kris said, get a walker (prescribed), and then see what they do with that! I also fully agree that the squeaky hinge DOES get the oil (attention). I can see them denying if you haven't tried conservative methods and all that, but other than that, they could be putting them in a bad position legal wise.

    We're here for ya woman!!! *HUGZ*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Ladies, I`m making plans for my next defensive action! I can now see, I never thought I`d need to handle my health care this way!!! Offense, is how I should have handled my insurance. How stupid of me, Fool me once shame on you, fool me twice shame on me! My only excuss,I thought my personal health insurance was on my side. Boy, talk about things have changed! So, I`m going to put my big girl pants on,tough up, and play hardball!!! Thank you all again! I think I`ll refer to ya`ll as the Spine-Health Super Hero`s!!! It feels so amazing to have the best people in the world,having-your-back,so to speak!!! Hugs,Brenda
  • What a difference a day makes! The orthro,spine surgeons in St.Louis called. Their proceeding with everything the surgeon thinks I need to have done. I really liked this surgeon, he gave me a great exam. He was very frank aout my insurance. Told me his experiance with Anthem was less than positive. He suggested I get in touch with my local ins. agent. So I did. He did his best to assure me Anthem would do the right thing. At this point, I hadn`t heard from him. So,I thought, he just was gaving me a pat on the head. Turns out he really got behind me!!! I`m so surprised, and pleased. Although, I can`t believe I`m happy to be having another discogram and mylogram. I guess I just know, they are very necessary. I want to get whatever I need done. So, at least for now we are making progress. Aug 22, is just around the corner. I`m finally going forward!!! Gentle hugs, Brenda
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