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Forced to get the wrong treatment due to insurance?! Where to turn?

LaurenBrianneLLaurenBrianne Posts: 25
edited 06/11/2014 - 8:16 AM in Health Insurance Issues

I am 21 years old and one of the best neurosurgeons in the state of Illinois has been trying everything to get my spinal fusion surgery approved. After trying everything they can, including appeals, I am forced to turn to having a neurostimulator device put in. I suffer from awful sciatica due to a disc space collapse at L5-S1. I have degenerative disc disease and had a herniated disc removed last January. I did great for a few months, but then my leg starting giving out and my doctor confirmed a disc space collapse and put me through injections and therapy. When those didn't help, we decided to schedule a fusion, but when the insurance wouldn't approve it we cancelled it and I've been stuck since. Are there any ways I can get through to Healthlink and get them to approve my surgery?? I can't live like this my whole life. Something has to be done.
Lauren Davidson


  • sandisandi Posts: 6,269
    edited 06/11/2014 - 8:16 AM
    You can again file for another appeal, and depending on the basis for the insurance company refusing the approval, you may want to consider talking with another surgeon to see if he agrees with your current surgeon.
    What is the reason that the insurance company is denying the surgery?
  • The insurance company says that it's not medically necessary.
    Lauren Davidson
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  • recommending? typically, when the insurance company refuses approval for a procedure, it is because there are other, lesser invasive options or treatments that have not been attempted or been attempted long enough. insurance follows a standard of care, similar to the steps shown in the step by step guide to treatment....i will post the link for you. it may be that they want you to try physical therapy again or more /different injections, prior to surgery approval.
  • I was turned down for a knee replacement a week before the surgery. The surgeon called the insurance company and did a peer to peer review of my case history. It was approved, many times the insurance company may not have the whole story and the surgeon can fill in the missing information that makes the surgery medically necessary.
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
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