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Neck surgery C5C6

I was supposed to have surgery but I was denied by my insurance company back in December because I didn't have 3 months of recent failed physical therapy. Well, after 1 denied appeal fast forward to today. I have completed 4 visits from physical therapy and she has dismissed me due it not improving but making things worse. I have a appointment with my surgeon on Wednesday and the insurance company says to have my surgeon resubmit the prior authorization to them again. I am hoping and praying it gets approved. But I don't have much faith anymore:(
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Comments

  • You may want to read the link at the bottom of my post , it explains the steps to getting chronic spine pain treated. Usually, as with almost every medical condition, they want to start with the least invasive, and then if the symptoms do not improve, or worsen, take the next step. I assume you have had imaging studies done to determine the problem is at C5-6?
    It's not unusual for the insurance companies to deny surgery at first, again, if a lesser invasive treatment might work, why put someone through surgery that may worsen or not improve the situation at all? As difficult as it is, it is in your best interest to try the other modalities available first, and if there is no significant improvement, then go into surgery.
    Hang in there,
    Sandi
  • This is a concern of mine as I am scheduled for a C5 C6 ACDF on April 10th. The surgery was scheduled nearly four weeks after my surgical consult, during which I was told this is what I need. (I fell from gymnastics equipment in PE class 30 years ago and landed really hard on the back of my neck, herniating the disc. Although I have suffered with pain ever since, no one seemed interested in helping me until it started affecting my arms, hands, and legs these past few months.) We have Blue Cross/Blue Shield, which drags their feet in approving such a surgery, the scheduler told us. I am now 11 days out from my surgical date and we have yet to hear that they have granted approval. Every day is a trial, as my pain and other symptoms are getting worse. I don't know what I will do if they refuse to cover the surgery.
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  • Jules27JJules27 Posts: 64
    edited 03/31/2014 - 2:22 PM
    I found out today that my surgeon's scheduler sat on the pre-determination paperwork, not faxing it to BC/BS for six days (despite having told me and my husband that BC/BS has been taking "weeks" to approve anything). Now my surgery is scheduled for nine calendar days from now and there is not enough time for approval to be granted. (BC/BS told us today they require 14 business days. Thanks to the lame brain in my doctor's office, they will only have 12.) I'm really scared because I'm in more pain and losing more function all the time. I don't know if they would have approved the surgery if given the proper amount of advance notice, but now, I'm likely facing a postponement of the surgery, if not complete cancellation. I am so incredibly angry and sad at the same time.

  • I am so sorry to hear you have been going thru all of this ridiculous nonsense with your insurance company! I cant believe that your health and well being and the pain that you are in day after day night after night does not make any difference to this insurance company!!!!!!!! I am praying that you get your approval and get your surgery that the DR recommended, now I know they only recommend surgery only after all other options have failed or of the patient is so bad it just warrants surgery PERIOD !!!!!! please keep us posted on what happens I am here for you if you need to chat or vent or need a laugh as I can be very funny even in my pain. 0: my surgery date for my cervical fusion on my neck is set for April 28th and that date couldnt come soon enough as I still work up untill that day as I need the income but we will see if I can make it till that day! good luck to you take care post when you can soft hugs ,
    Stacy (:
    ACDF One level C- 4 April 2014
    DDD
    Cervical Spondylosis \ Myelopathy
    Chronic pain sufferer since 2005
  • Thank you, Stasiamarie! It is more the scheduler's fault than the insurance company at this point. I didn't mention it, but in addition to screwing up the insurance pre-approval process, she also sat on the paperwork required for my husband to get five days off to care for me post-surgically. I gave it to her on March 21st and she STILL hasn't filled it out! Aaaarrgghh!!!! Like you, I am trying to keep working, but it's tough. I run my own business from a home office, which helps, but I have clients who depend on me and it's getting harder and harder to deliver the services they pay me to do! April 10th couldn't come soon enough, but now, it may have to be later. I am crushed. :-(
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  • Jules, sounds like the doctor may need to hire a new scheduler, because that screw up did not need to happen. It caused you a delay, but probably will not cause any permanent harm. Your insurance company should have no reason to delay authorizing your surgery, because of your increasing pain and loss of function. good luck!!
  • Have you tried pain management first. Because once you remove something you can't get it back. For example, I have been having Chest Pain, Pain in the back of my neck, some of my words are not coming out and headaches.
    leslie.wasson said:
    I was supposed to have surgery but I was denied by my insurance company back in December because I didn't have 3 months of recent failed physical therapy. Well, after 1 denied appeal fast forward to today. I have completed 4 visits from physical therapy and she has dismissed me due it not improving but making things worse. I have a appointment with my surgeon on Wednesday and the insurance company says to have my surgeon resubmit the prior authorization to them again. I am hoping and praying it gets approved. But I don't have much faith anymore:(
  • Is there anyone out there that are having Chest Pain, Difficulty swallowing, impairment of or change of speech, blood clots, change of mental status, inability to resume activities of normal daily living, including sexual activity and above all tightness of the chest.
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