Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!


Quick Start Forum Video Tutorial

Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

The main site has all the formal medical articles and videos for you to research on.

IraqI Vetran denide Lumbar Fusion surgery

edited 04/09/2015 - 7:56 PM in Health Insurance Issues
I'm 46 years old male I served my country for over 17 years in the Navy and I served my home state as a Texas State trooper for 6 years. Since I finished serving my country since March 2011 my condition of my back have deteriorated to the point I'm afraid of leaving my house for fear of falling due to severe pain in my back, legs and so on. My doctor told me to try physical therapy, Lumbar injections (2). I am over a year into my pain management with no relief. I was just informed that my first appeal was denied for a Lumbar Fusion surgery. My knowledge is not up to par on this matter and I would appreciate any advice on what to do next. I just want some relief .
Barron W. Camp


  • LizLiz Posts: 9,745
    please take the time to read this post and refer to it when you have questions

    i am sure that you will find your time on spine-health very rewarding. this site is a powerful and integrated system that is dynamic and growing.
    here are just some of the highlights that are available as tabs on the main spine-health menu bar

    spine-health main menu tabs

    conditions detailed medical libraries of articles and videos that address almost every spinal condition.
    treatment list of treatments to the conditions identified by spine-health.
    wellness section contains articles, tips and videos to help patients after surgery and also to help people avoid surgery.
    medical articles
    pain forums these are the forums you will be using
    find a doctor this provides with a method to search for doctors in various locations.
    videos index to all spine-health videos

    as a bonus, spine-health provides these patient forums. here you can meet thousands of people who understand and can relate to your situation. you will soon become part of the spiney family[/u] who provide comfort and the advantages of a support system. you are now part of this family that is approximately 27,00 international members and growing daily.


    - it is very important to understand the forum rules to make sure all of your posts[u] do not violate any of the rules.[/u]

    - all new members must read our faq in order to understand the layout of the forums, how to navigate through the forums, helpful terms, how to make effective threads and posts, plus a link index to many of the important medical forums and key medical articles on spine-health forum faq

    i am positive any member, new or old will find this chroinc pain - step by step thread very valuable.

    here are some links that all new members need to review to create effective threads and more

    read before you post
    tips for newcomers
    understanding the rules

    all of this will help make your threads better and improve the times and quality of responses you will receive.

    you can also find spine-health on these social networks

    facebook www.facebook.com/spinehealth
    pinterest https://pinterest.com/spinehealth/boards/
    twitter https://twitter.com/spinehealth

    if you have any questions or need assistance, you can use the private message facility to[u] contact any one of the spine-health moderators



    doug hell

    also working with us very closely is allison walsh from the spine-health company



    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • SavageSavage United StatesPosts: 7,385
    And thanks for serving!
    I totally relate to your fear of falling. Although we may have different spinal issues..we share the fear of falling.

    I was falling.. and initially it happened unexpectently..no warning...just one second I'm upright and then I am laying on my back.
    Using a cane has helped me so much..with balance and with the pain of walking. But...I can and do still fall on occasion eve with the cane...so yes my getting out of the house is limited also.

    It's great you are with pain management! I've been under PM care about 7 years now. Realizing all spinal issues and treatments are individualized.....I felt more under control almost immediately, but for finding right combo of pain med and breakthrough pain med..took awhile for me.

    I am not a candidate for surgery. But it saddens me greatly to hear you were denied your needed surgery, esp. as you are a veteran, I would like to think your insurance would be backing up your doctor.

    Sorry I have no advice for you, but hopefully someone will come around who has similar experience which may help you.
    Hopefully some of the info referred to by Liz, above, will be helpful.
    Please keep us posted on how you are doing and any guidance you can get form your doctor.
    Best of luck
    Honorary Spine-Health Moderator
    Please read my medical history at: Medical History

  • advertisement
  • Did you have any treatment for your back or did you identify back pain while you were with the military? If so, it may open more doors for treatment.

    Are you going through the military or other insurance for the procedure? Where I'm going with this is that if you got hurt initially with the military, you may options for them to pay for it. I'm not sure how Tricare works now, but when I retired in 2005, the military was responsible for further treatment especially if you were hurt while deployed.

    With private insurance, if you need a spinal fusion, it should be submitted by the surgeon doing the procedure. It's not uncommon to be denied the first time. The surgeon's office should re-file and add additional information.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I'm a certified medical biller and coder, can I have some things clarified ? Are you going through the VA? If so, I would immediately request to be seen by non-VA doctor ASAP. If the injury occurred in the line of duty or if you have a disability rating related, the VA has to pay.
    If it's private health insurance, call and file a member appeal. They tend to look at those more than a provider appeal.
    Hope that helps! Thank you for your service.
    Cauda Equina post MVA
    T-12/L-1 fusion, Thanksgiving 2014
  • thank you so much for serving our country!!!!

    to get migraine medication i had to appeal three times. this is not uncommon for some insurance carriers. the other option is to contact the texas insurance department.

    C4-C5 ACDF surgery with plating August 28.
    cord compression due to disc-osteophyte complex
  • advertisement
  • jlrfryejjlrfrye ohioPosts: 1,111
    The Dr uses incorrect diagnosis or coding of the procedure. Make sure all previous treatments are included with the prior auth. Most surgeries will not be paid until certain requirements are met such as injections and PT. This could be a oversight on the Dr's part. Call your insurance company and find out why the denial. That way you will have a idea where to start with the appeal
  • big man, I appreciate you. All those years of looking out for us, wow..I really don't have the words, but thanks you.

    Appeal! I'm so sorry this has happened to you, especially the pain and the wait. I have no help to offer and hope some of the other suggestions help you to get to healing. My dad had a similar experience. He appealed. It was the coding and the infejections. They did an injection, resubmitted and he was cleared to have the surgery. That was 15 years ago, he is doing great. Best wishes for recovery!
Sign In or Register to comment.