I re-read your post and wonder: what kind surgery you have if it only 1 night at the hospital? I don't believe it can be fusion, with fusion they tell you right the way it 4-6 days.
Someone with complications stay longer. I was told 4-6 days and came home only 3 weeks later after my second surgery and 2 weeks after my first one so all depends.
Yes, usually Nurse knows your case and she knows how many days you stay after particular surgery. Just strange to me if you do have fusion (now I am not sure) they tell you only one night.
I have probably a strange question. If you get it fused and have the plate with screws or whatever does it matter if the fusion takes with how the plate and screws stabilize the spine and keep the right space? I had my C6 fused with the plate and screws and they didn't take the hardware out later.
I re-read your post and wonder: what kind surgery you have if it only 1 night at the hospital? I don't believe it can be fusion, with fusion they tell you right the way it 4-6 days.
Someone with complications stay longer. I was told 4-6 days and came home only 3 weeks later after my second surgery and 2 weeks after my first one so all depends.
Yes, usually Nurse knows your case and she knows how many days you stay after particular surgery. Just strange to me if you do have fusion (now I am not sure) they tell you only one night.
:-)
Moldova
Doc told me fusion and hardware. I think nurse might be messed up because I think doc had said 3 days. I had gone for second opinion with a surgeon in Milwaukee and he said 5 days. Since Milwaukee is about a hour and a half from me my wife and I decided it would be easier on everyone if I just have it in town.
Regarding the hardware, the lumbar spine has more stress placed on it than the cervical area where motion is more limited.
However, my answer relates to fusion in general. Hardware is not designed to hold the body in place forever. It takes the place of a brace. When a bone breaks in the leg or arm, doctors are able to stabilize the bones while they knit together by using a cast. This is not possible or at least, not desired, in the spine so in times past, a brace was always used until the bones had set up and knitted together.
Now with advances in medicine, they often use hardware to hold the bones securely in place while the body grows new bone...but the hardware is not designed to take the place of solid bone growth. Without bone, and continual motion in that spinal segment, the screws will eventually loosen and the segment will develop instability.
Just think of two pieces of wood held together with a screw. The connection may start out tight, but if the wood is wiggled and moved around, eventually the connection will loosen, and eventually the size of the hole may start to enlarge...then all aspects of the connection begin to become problematic. The hole enlarges, the screw loosens, the pieces of wood begin to separate, etc.
Surgeons do not remove hardware unless there is a reason to do so, such as an issue with something breaking; the screw is not in the right location and it is causing a problem such as piercing a nerve; the fusion only partially grows together and there is sufficient instability that there is movement, or enough space that a nerve ends up being irritated or compressed due to the instability, or the person has a sensitivity to the metals used in the hardware.
I had hardware removed when I had a revision surgery because the screws turned out not to be compatible with the new hardware the surgeon was installing.
The Following User Says Thank You to teteri66 For This Useful Post: mzahn (06-02-2012)
I need help, suggestions. Today my surgeons office called and said that they just found out my insurance company denied my surgery. What the heck!!! They said it isn't necessary. I have 2 surgeons, one which was a second opinion, and my pain management doctor who all say I do. They also are very confident because of a test that the disk that will be worked on is the pain generator.
Anybody have suggestions what I should do? I called my insurance but it was later in the day and of course just got someones voicemail so I will try again tomorrow. I don't know how I will be able continue with this pain. I need this surgery.
The following user gives a hug of support to mzahn: SweetPeainSF (06-07-2012)
Location: San Francisco, California, United States
Posts: 701
Re: Question about surgery
What is the insurance company's appeal process? When I had to get approved for jaw surgery back in high school, the insurance company required me to go to another doctor (either one they chose or an independent one).
Also, when you go to doctors, make sure that you are not under-reporting symptoms (don't lie, obviously, but don't give overly optimistic answers). I made the mistake of being overly-optimistic about my nasal breathing. I was only 16 and in really, really good shape, so no, I did not have shortness of breath after walking up a flight of stairs while breathing through my nose. Because of answers to those types of questions, I was not approved for simultaneous surgery to fix my deviated septum. Now I realize I probably really needed the septum fixed, but I'm not willing to have an independent surgery for this purpose.
Last edited by SweetPeainSF; 06-07-2012 at 11:01 PM.
Reason: typo
Don't panic. It was 15 hours prior to a 3 level fusion, when my insurance carrier denied my coverage. The standard line is that it has not been shown that the surgery is "medically necessary." Often the surgeon's office will handle the initial step, which is a "doctor to doctor" review, where your surgeon will talk to the insurance carrier's orthopedic doctor, describe what he wants to do and why and often, that is the end of the problem. Your insurance carrier may be different, but I understand that is pretty typical. Maybe you should call your surgeon's office and ask them to provide you with some direction. Usually there is a person who calls to get surgical approval and that person will be able to suggest what will happen and how to appeal the decision.
I wasn't that lucky, so I had to file a formal appeal. It ended up taking several months longer, which was incredibly stressful.
This is one reason why I try to get the word out that people should get copies of every test result, copies of MRIs on CD, copies of doctors' notes, etc. You never know when you just may have to drag them out for reference, or for a situation like yours. This is especially important if the person is seeing more than one specialist, like an ortho spine surgeon, a neurosurgeon, a physiatrist or pain management specialist, a neurologist, etc.
I know how devastating this news is, but try to regard it as just one more hurdle you have to jump over -- remain calm so you can think clearly, and start gathering the information you need from the insurance company and that person in your doctor's office who is used to dealing with the insurance carriers. Let me know how you are progressing. I may be able to offer some tips.
May I ask you if lawyer involved in it? Is it a car accident or working comp or any suing involved?
I have good suggestions for you, but please let me know first.
Don't panic. It was 15 hours prior to a 3 level fusion, when my insurance carrier denied my coverage. The standard line is that it has not been shown that the surgery is "medically necessary." Often the surgeon's office will handle the initial step, which is a "doctor to doctor" review, where your surgeon will talk to the insurance carrier's orthopedic doctor, describe what he wants to do and why and often, that is the end of the problem. Your insurance carrier may be different, but I understand that is pretty typical. Maybe you should call your surgeon's office and ask them to provide you with some direction. Usually there is a person who calls to get surgical approval and that person will be able to suggest what will happen and how to appeal the decision.
I wasn't that lucky, so I had to file a formal appeal. It ended up taking several months longer, which was incredibly stressful.
This is one reason why I try to get the word out that people should get copies of every test result, copies of MRIs on CD, copies of doctors' notes, etc. You never know when you just may have to drag them out for reference, or for a situation like yours. This is especially important if the person is seeing more than one specialist, like an ortho spine surgeon, a neurosurgeon, a physiatrist or pain management specialist, a neurologist, etc.
I know how devastating this news is, but try to regard it as just one more hurdle you have to jump over -- remain calm so you can think clearly, and start gathering the information you need from the insurance company and that person in your doctor's office who is used to dealing with the insurance carriers. Let me know how you are progressing. I may be able to offer some tips.
You were pretty much right on. I called the insurance company and he gave me the same bs that it was considered not "medically necessary." He told me 2 reasons when they said it would be but I was so angry I only remember one. Bone on bone. I asked him what to do now and he said have the surgeon talk to their guy. So I called my doctors office and asked for them to set that up. Now I just cross my fingers and wait. You would think a lot of people get stuck in this game they are playing. You wish you could transfer your pain to whatever so called doctor who made this decision for the insurance company even for just a day. Well wish me luck and I will let you know. Thanks.
May I ask you if lawyer involved in it? Is it a car accident or working comp or any suing involved?
I have good suggestions for you, but please let me know first.
Moldova
No. Just good old DDD. Have had back problems for most of my life.
First of all, I am so sorry. I just can imagine how frustrated it is for you. I want to share with you my experience and what i know about it.
1. My surgery needed since 2003 after car accident. Even though I was told I cant walk around with damages like this and need surgery, I was very afraid to loose my job, etc and didn't go until 2006. But when i decided to go, 3 days before my surgery, Lady's insurance who was suppose to pay for my surgery, refused saying it not a must surgery. First of all, how in a right mind would go for spinal surgery if it not a must and if they didn't suffer already a lot? Second of all, I am the one who put the surgery off for 3 years suffering but not going and when spinal/limb nerves got damaged and i faced paralysis, I had to go. They refused that time.
My lawyer fought with them, they agreed to pay, i made all arrangements at work and home and the day before surgery, they refuse again.
Now I know why I understand what you are going through. We decided to go ahead with surgery anyway through my medical insurance and than sue them. My insurance paid it all and then they got their money anyway from them - but the price of playing these inhuman games just frustrating, is in it?
2. My ex-boss had same situation you have; she had DDD and stenosis. She was so bad and only 50. Since many surgeons don't do surgeries on these type issues claiming it degenerative, we all go through this and even after surgery same issues come back ( mine all came back, but i had many other problems due to car accident which needed to be fused and changed). So insurance told her this degenerative, no need of surgery.
Poor woman, had to go to her lawyer, he appealed and got NO again. They sue her company. Eventually she got her surgery, but it took such a long time over a year to fight all this and of course a lot of money to her lawyer.
Please let us know what will be the final decision for you. Dont get disappointed, fight as much as you can. Its your life, you have to have some quality to your life and if you went for couple opinions and all of them suggest surgery, fight!!
Best wishes
Moldova
The Following User Says Thank You to Moldova For This Useful Post: mzahn (06-08-2012)
Don't panic. It was 15 hours prior to a 3 level fusion, when my insurance carrier denied my coverage. The standard line is that it has not been shown that the surgery is "medically necessary." Often the surgeon's office will handle the initial step, which is a "doctor to doctor" review, where your surgeon will talk to the insurance carrier's orthopedic doctor, describe what he wants to do and why and often, that is the end of the problem. Your insurance carrier may be different, but I understand that is pretty typical. Maybe you should call your surgeon's office and ask them to provide you with some direction. Usually there is a person who calls to get surgical approval and that person will be able to suggest what will happen and how to appeal the decision.
I wasn't that lucky, so I had to file a formal appeal. It ended up taking several months longer, which was incredibly stressful.
This is one reason why I try to get the word out that people should get copies of every test result, copies of MRIs on CD, copies of doctors' notes, etc. You never know when you just may have to drag them out for reference, or for a situation like yours. This is especially important if the person is seeing more than one specialist, like an ortho spine surgeon, a neurosurgeon, a physiatrist or pain management specialist, a neurologist, etc.
I know how devastating this news is, but try to regard it as just one more hurdle you have to jump over -- remain calm so you can think clearly, and start gathering the information you need from the insurance company and that person in your doctor's office who is used to dealing with the insurance carriers. Let me know how you are progressing. I may be able to offer some tips.
I called and asked if my doctor could call the insurance company and talk to their so called doctor. Any wild guess how long this might take to hear the answer. I would think my surgeon would do it quick because the surgery is or was suppose to be 6/18.
As I indicated in my other post, most surgeons have a staff person who schedules surgeries and is used to dealing with various insurance companies. I never got involved with my insurance carrier until after the initial denial. "Barb" did everything...and the surgeon to surgeon review took place almost immediately. This is usually the first time a doctor gets involved.
Most, or perhaps I should say many, insurance companies use what is called the Milliman Standards of Care, which is relatively new. It is a rigid set of criteria that patients must meet in order to have a particular surgery. It was implimented in Jan. of 2010. I remember well, because I was debating having my surgery in Dec. or waiting until after the holidays...decided to wait...and then really ended up waiting when my surgery coverage was denied. I was my surgeon's first patient that had coverage denied so we had several conversations about what was going on. It basically takes the decision-making out of the hands of surgeons and establishes what criteria a patient must meet to qualify for a particular surgery. Two years ago, I could have told you in detail what all had to be "wrong" in order for the patient to "qualify" for the surgery. If you don't meet every one of the criteria, your surgery is not "medically necessary" and they will approve it.
Hopefully your doctor will talk to their doctor and explain why you need the surgery; he will agree, and that will be the end of it. If it is denied, you will then have an opportunity to appeal the denial...but we'll keep our fingers crossed that things will be resolved with the doctor to doctor review.
Hang in there. I know how stressful this can be.
The Following User Says Thank You to teteri66 For This Useful Post: mzahn (06-10-2012)
Well my doctor doesn't even want to try doing the doctor to doctor talk with insurance. I will try write a formal appeal. Very disgusted and depressed.
The following user gives a hug of support to mzahn: SweetPeainSF (06-19-2012)
You're kidding. I've never heard of that. If he believes you need the surgery, the doctor is usually willing to talk to them. Did he say why he wouldn't do it? The Peer-to Peer review is the next step. If he won't do it, I'm not sure how the insurance company will interpret that....
Also, unless your carrier is different from most of them, the process is the peer to peer review, and then if that is denied, the client can make a formal appeal. However, if that is denied, there are not more options with the insurance company. Most states have an appeal process that can be attempted when the other appeals have failed -- but it is the end of the road.
You're kidding. I've never heard of that. If he believes you need the surgery, the doctor is usually willing to talk to them. Did he say why he wouldn't do it? The Peer-to Peer review is the next step. If he won't do it, I'm not sure how the insurance company will interpret that....
Also, unless your carrier is different from most of them, the process is the peer to peer review, and then if that is denied, the client can make a formal appeal. However, if that is denied, there are not more options with the insurance company. Most states have an appeal process that can be attempted when the other appeals have failed -- but it is the end of the road.
My whole contact with this surgeons office has been through his nurse who makes you feel like you are bothering her. She first told the surgeon about the insurance on this past Thursday I think. Today I called and she said that he hasn't had much luck with peer to peer talks. Just sounds like he is giving up on it and me before even trying.
I told my pain management doctor and he was mad. He told me to bring the letter from the insurance to an appointment on this Wednesday. I am hoping I can come up with some plan with him. Also the MRI that the insurance must have looked at I believe is atleast 7 months old so maybe another one also maybe the other surgeon from Milwaukee I saw first who had started with the insurance before I wanted to go with the hometown surgeon. I know my pain has gotten much much worse since that MRI. Sorry for rambling. I am just blown away.
Don't apologize. I understand exactly how devastated you are as I went through the same thing...only in my case I had only about 12 hours to go before surgery...so everything was all set, daughter was taking time off work to be with us for the week after surgery, etc. All I could think about was what would I do if all my appeals were denied...
May I ask which insurance carrier you are covered by?
Don't apologize. I understand exactly how devastated you are as I went through the same thing...only in my case I had only about 12 hours to go before surgery...so everything was all set, daughter was taking time off work to be with us for the week after surgery, etc. All I could think about was what would I do if all my appeals were denied...
May I ask which insurance carrier you are covered by?
Anthem Blue Cross Blue Shield.
Do you think it would be smart to have another MRI if it was that long ago?
