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I have always been positive

when it comes to so many issues regarding spinal problems and its treatment.

I have digressed a little.

I've always believed in the medical industry and always will. I have seen so much of what they can do. Being a partner to someone who is in the medical field, I have have knowledge of the hundreds of patients that have been save because of our doctors, nurses and more.

However, so much has changed over the past several years. What my doctors would approve and say is fine, today, they are rejected. Not because they dont believe it, or write the proper justifications, but its because the insurance companies have dictated what is ok and what is not.

That is so wrong and so sad. When a doctor can prepare all the justification for a patient to do this or that, who says that the insurance companies, without the medical degrees can make decisions. I find their acts so wrong and so against the overall welfaer of the patient.

Its probably no different than insurance companies for autos. You pay many years of premiums, but then when you have an accident, one of the first things they do is increase your premium! You pay for years and years that amount to much more than a claim, but yet, you are penalized.

The same hold true for medical insurance. It really doesnt matter what the doctor says anymore. Why? That is not right.

I dont want this to sound is if its about me... I have an upcoming ankle reconstructive surgery. Sometime in late March. I will need to have no weight bearing for about 5 weeks. Its going to be hard, but between what we can rent from medical supplies, my old crutches, we will do. But based on my existing condition, numerous surgeries, always with complications, you would hope that I could stay in a hospital overnight. My doctor totally agrees. He has already written two letters of necessity ( I have seen these letters), explaining why as a chronic pain patient , with multiple surgeries and documented complications that staying 1 night after the surgery is medical warranted. The insurance company says NO

I am not as so concerned about myself, since my wife is a medical professional, she will be able to take care of me. But its the attitude and direction that the insurance companies are taking today.

This scares me. We (all of us) pay a lot of money into medical insurance premiums, but yet when we really need them or could use them, we re denied.

I am sorry, as moderator I should not be making these negative comments. But right now, I am speaking as a patient and I hope for other patients. I dont know how all of this stops or can be corrected, but I do know that this mode can not continue.

I know someone close to me, that had some serious medical problems, they were hospitalized for several days. When it came to paying up, they didnt have any medical insurance. They were not kicked out, the medical field still holds to their oath in providing medical assistance to anyone, regardless of their ability to pay for it. Instead, this person was given a much reduced cost of services and allowed to pay over time.

The medical field knows about the lack of justice in this.... but where is the heart of our insurance carriers? Yes, I am sure that many folks abuse insurance and that is also wrong, but what about people that pay when they are suppose to pay.

I apologize again, I just feel this is so wrong and I dont know how it can be made right.
Ron DiLauro Veritas-Health Forums Manager
I am not a medical professional. I comment on personal experiences 


  • This is all so true, I am also thinking about this lately. When I had all of my previous surgeries even my big 3 level corpectomy/fusion I was a out patient (23 hours) . I had to be sent home on a four hour car ride. My doctors filed appeals and lost. I will being having a revision soon and I'm sure I'll be a out patient again. I think there is a potential for serious complications that could be better controlled if the patient stayed in the hospital. The time needed to return to the ER could be more costly to someone's life and end up costing insurance companies more in the long run.
    2005-ACDF with Corpectomy at C3-C-5.
    2006-L4-L5 diskectomy.
    2009-Cervical laminectomy at C3.
    Steroid injections series x 4.
  • and while we're at it how about the highway robbery the hospitals charge for hardware. I got an itemized print out of my whole weeks stay in the hospital for my accident and fusion surgery. I about crapped my pants when i saw the total. The ridiculous thing was what they charged for the pedicle screws they put in me. I have an acquaintance who works for a vendor that supplies hospitals with medical implants and I asked him how much the screws, rods and cross links generally run for back fusions and this is what he told me. " A couple yrs ago, Spine companies charged the hospital: $1,500 per cross link, $1,300 per screw, and $350 per rod. Today, it's $750 per cross link, $700 per screw, and $150 per rod. The Hospital in turn, charges a lot more! " Alot more is right, try a ton more. I have 10 screws in my spine now that the hospital billed for close to 14 g's PER SCREW!!! No wonder insurance companies dont want to pay up and people like us have a hard time paying off medical bills. It's ridiculous, disgusting and down right wrong.
    September 2014 : T6 burst fracture, multilevel fusion from T4-T8
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  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    First dilauro, I have always been the moderator of sites and it sucks to always pretend that the pain, anxiety, whatever is behind me. No one would respond to my posts because, "Oh Sheila knows what to do!" but it's not about that either. It's about being in the same boat and dealing with the same stresses without the mutual support.

    I have been on Medicare since I was about 24 (now I am ancient at 48!) Sometimes I'd have a secondary insurance and lately, not. It would depend on what state I lived in at the time. Maine was great offering free heath care but so few doctors you would have to travel out of state where state insurance did not apply!

    Many, many of my friends are doctors- just happens like that. I have worked in various fields but have never even played a doctor on TV. One thing is, doctors have NO idea how much things cost. Don't blame them! One of my friends received some letter from propaganda trying to show how her practice is affected by insurance and showing all the line items . She and I went on a quest and found the origins of that propaganda. Those items denies had been double billed! Another had been "Medical records updated, height, weight, BP"...... $57. There is a game going on by both the medical offices and the insurance offices. We overbill because we know that insurance is going to pay just a bit and then we may balance out. Well, the accountants make out.

    With medicare I can have an MRI without requests and referrals. To me, this makes so much sense, get to the base of the problem by getting a correct diagnosis before having patients go through hoops which cost money and may not be effective at all. But my medicare co-pays kill me too. I cannot do regular work for extra money and thus I'm always behind getting stressed which makes me get sick faster...

    My desire would be having a committee of educated consumers, physicians, and insurers but I have never seen a committee work anything out without looking like the state of the United States Congress right now. Transparency seems to make so much sense if only someone would have the courage to go first!

    Finally, I have been in the hospital for in and out surgeries. Once the surgery is over the surgeon usually tells the insurance company that if I were to go home I would die. Insurance companies get very careful when it comes down to this but surgeons cannot adamantly say this until post surgery.
    Wishing you well,

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
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