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Do insurance companies ever pay for Cervical Discograms?

I have a long history of neck issues because of severe whiplash injury 38 years ago.  I didn't get my first fusion until nine years ago, so the statute of limitations long ran out against the guy that rear ended me.  I never fully recovered after my second fusion two years ago and now the neurosurgeon that performed my last fusion thinks that I have an additional two level disc failure that is NOT fully explained by recent tests, including an MRI.  He ordered a two level cervical discogram that the insurance company refuses to approve.  They claim that cervical discograms are "experimental".  After it was denied in March, I asked the neurosurgeon and insurance company case manager if I should go ahead and pay it myself, even though I don't have the $3,000 or so money to throw around.  I got a resounding NO from both the neurosurgeon and case manager who both clamed that if I got positive results from a self paid test that showed that I needed surgery, the insurance company promised to fight me on any surgery costs.

The other day, I got notice that the insurance company denied my neurosurgeon's appeal.  I'm still waiting for the official reasons.  I am scheduled to "discuss options" with the neurosurgeon in four weeks.  I rather stuck with this neurosurgeon, since he is the only one that has been willing to take on my case.  Has anyone ever had an insurance company pay for a cervical discogram?          



  • nutcase007nnutcase007 United StatesPosts: 947

    I think I got my answer since no one left any updates in my question.  It appears that no one reading postings on Spine-Health has ever had an insurance company pay for a Cervical Discogram.

    Would anyone please post their experience of insurance companies paying for any Discogram?  Thanks...   

  • SavageSavage United StatesPosts: 7,385
    Health insurance companies can have different coverages.
    If you are looking for other insurance co that does cover your procedure, you may need to do comparisons by research on the net.

    Honorary Spine-Health Moderator
    Please read my medical history at: Medical History

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  • nutcase007nnutcase007 United StatesPosts: 947

    I painfully learned after the fact, if one insurance claims a procedure "experimental", more other insurance companies will do the same.  I addition, if Medicare lists a procedure experimental, almost always all insurance companies will do the same. 

  • Another option you may want to check is with your State Insurance Compliance Office.  In my State, you can call and ask about specific laws that may give you recourse to challenge denials.

    I know it's not much, but hopefully this will help a little.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • nutcase007nnutcase007 United StatesPosts: 947

    Post surgery note (my fusion surgery was January 12, 2018).  After being "left to rot" for two years, my neurosurgeon was able to get me classified as "gross cervical instability", so he was authorized to perform fusion at C4/C5.  This was the last cervical level from C2 to C7 that was not fused.  After surgery, my neurosurgeon informed me that if I would have been allowed to have the Cervical Discogram two years earlier, it would have diagnosed my C4/C5 failure and I could have had surgery two years earlier. 

    I'd be lying if I said I don't have negative emotions about insurance companies.   

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