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    Old 10-04-2011, 09:05 AM   #1
    andrea32225
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    a bit of hope?

    I finally have a repeat microdiscectomy scheduled. According to the pre-cert coordinator at my surgeon's office, as long as the surgery is outpatient, BCBS does not require pre-cert (and she has the name of the person with whom she talked). However, the soonest the surgeon has an opening is the 20th.

    There are two patients (one w/surgery Thursday and the other with surgery Friday) that are requiring cardiac clearance and still haven't received it yet. If either one of them gets denied, then I've been told I'll get their surgery time.

    I hate to wish bad luck on anyone, but after what I've been through these last couple weeks...

    So, they've cancelled my dr appt for tomorrow, but I'll go pick up my medication refills tomorrow and at least be somewhat comfortable until whenever my surgery happens.

    I'm just curious what happens if the surgeon gets in there and finds so much damage that a fusion is required - knowing it's already been denied. Does he close me up, give me a brace or something, and try to get pre-cert again, or does he just do the fusion while he's in there b/c of the circumstances? I'm thinking there's not going to be a lot of disc left, and yes, I want the fusion. All the clinical literature I've seen says that a MED is not for back pain, it's for leg pain. I don't have leg pain, but if it's a stopgap measure, I'll take it.

     
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    Old 10-04-2011, 09:45 AM   #2
    cheryl1213
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    Re: a bit of hope?

    No insight...just hope it provides some relief and glad to hear you have some hope. Focus on that, not the worrying (easier said than done, i know!)

     
    Old 10-04-2011, 05:31 PM   #3
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    Re: a bit of hope?

    Don't have surgery if you don't think it's going to solve your problems. Please continue to pressure everyone involved until all avenues are exhausted. My surgeon told me that a diskectomy would not relieve my back pain. Are you really going to hope that the surgeon is going to go ahead withthe fusion once you get opened up? Are you sure this surgery is the right thing to do. Please don't let desperation lead you down the wrong path.

    Only you know how bad your pain is and what you can take. Frankly, the idea of having a surgery just because the insurance won't have a say-so in it makes me nauseous. Please, please make sure you've exhausted all your options and really feel that this is the right thing before you go through with it. Does your doctor think you'll need another surgery after this one? Does he recommend this surgery for your back pain? Pain is a terrible thing that can cloud judgement. Push that insurance company until they give in. Pester your doctor until you get what you need. Imagine waking up from surgery -- the back pain is still there and for some reason your legs are now a problem. Any back surgery is serious. Think very carefully before you do something that can't be undone.

    In the end, it's your choice, of course. No matter what you do, I wish you only the best.

     
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    Old 10-05-2011, 08:12 AM   #4
    andrea32225
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    Re: a bit of hope?

    I thank you for your message and totally appreciate what you are saying. I, too, know that the MED is not designed to cure my back pain. However, the criteria under which BCBS will approve a fusion are VERY limited. I'm guessing 1 out a 1000 people qualify under the first try. Unfortunately, under the Milliman guidelines that they use to make their decision, there is NO WAY I qualify for the fusion unless I somehow manage to fracture my spine or my spline starts slipping. The surgeon can do a laminotomy or stuff like that, but nothing that's inpatient.

    The question is if the herniated disc isn't the source of the back pain, then what is? I'm at the point where I'm willing to try anything that might give me relief, even temporarily. Even with 2 Percocets in me, I'm never below a 6 in pain and usually at an 9.

    IYHO, Should I try to get into Mayo's Spine Center? The thing is I have to have a referral and I'm not sure my Baptist PCP or Neurosurgeon would be too keen about that...

     
    Old 10-05-2011, 08:27 AM   #5
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    Re: a bit of hope?

    Andrea -- Going to the Mayo Clinic is not going to change the criteria for BCBS paying for the fusion...so I don't feel it would make any difference. You seem to have confidence in your surgeon and his diagnosis, and I suspect you would get the same/similar diagnosis from the Mayo Clinic doctors.

    I'm not sure where people got the idea that a fusion will take care of back pain...because there is no guarantee of that. In fact, if you look at the statistical information for rates of success, you will see that it is most effective when most of the patient's pain is coming from the leg and not the back.

    I think back pain is hard to diagnose and difficult to address. I can't think of anyone I know who had back pain and then had fusion, and is now mostly free of back pain.

    On the other hand...I just happened to think: Have you only seen a neurosurgeon or are you seeing an ortho spine surgeon? I'm sorry but I can't remember.

    Last edited by teteri66; 10-05-2011 at 08:29 AM.

     
    Old 10-05-2011, 08:44 AM   #6
    andrea32225
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    Re: a bit of hope?

    I like my surgeon, but there's something wrong with this back. There have been no nerve tests done to figure out why I have little to no right leg function, and he's not going a good job of controlling my pain. I just live with what he gives me and deal with it.

    My thought about going to Mayo is that everything is in one place - every specialty, every lab work you need. Maybe they can find something there - the only tests I've had were 2 MRI's (one of which said was w/imaging but they never injected anything).

    When you filed your appeal that went through - you had spondy, correct? I don't, so I figure there's no use in even trying even though they've screwed up. Maybe the MED will give me at least a week or two or less pain (that's about it was last time).

    Oh yeah - i found Cigna's coverage guidelines online, and it says they cover a fusion as medically necessary for a recurrent disc herniation. Oh, why couldn't I have Cigna?!?

     
    Old 10-05-2011, 10:53 AM   #7
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    Re: a bit of hope?

    Andrea, I really am sorry that you've had so much trouble being approved. I have BCBS and never have had much trouble being accepted for a procedure. They did raise an eyebrow over a CT myelogram one time. I called to find out what the problem was and it was simply a matter of a letter from tmy doctor.

    Not being approved for a procedure you need must be tremendously frustrating. Getting into Mayo is not as tough as some might have you believe, but teri is absolutely right when she says your insurance isn't going to care about your hospital, only the need for the procedure. If you don't mind, what are their reasons for turning you down? What did your doctor say about that?

     
    Old 10-05-2011, 11:16 AM   #8
    andrea32225
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    Re: a bit of hope?

    Reasons in denial letter: (1) must have 3mm or more of spinal slippage (2) further disc removal must be to the degree that future spinal instability will be created
    Emergency denial (the one I filed): take all that and add that I don't have a recurrent herniation or any nerve impingment (which I do -supported by the MRI report that was done post-op and attached).

    I was told on my referral to the neurosurgeon that I have DDD, but they haven't said anything about it since I've been there (and I have all the office visit notes). Looks like I'm just stuck being in pain the rest of my life unless the repeat MED on the 20th takes out so much disc he has to do something else (but from my determination, even that's not allowable through them). If I had Cigna, I'd have the surgery and be recovering now! (and not be falling getting out of the shower like i just did - and now i cant feel my foot)

     
    Old 10-05-2011, 11:20 AM   #9
    teteri66
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    Re: a bit of hope?

    How does your surgeon know that you might not have something else causing pain in addition to the disc herniation? I haven't had a surgeon who believed in performing discograms so can't comment on that, but have you had a diagnostic nerve block or something like that? Did you ever have a flexion/extension x-ray to check for spondylolisthesis? (It isn't always obvious on MRI).

    I had spondylolisthesis as the main reason for my first fusion (and first surgery ever), but when I was denied the 2nd fusion, it wasn't enough to have a spondylolisthesis. There were a couple other hoops to jump through as well, including proven radiculopathy. My question was "what do you take for "proof" since you will not accept the results of a EMG and nerve conduction study?"

    Did you notice that being in pain is not included in any criteria for having surgery? I thought that was interesting.

     
    Old 10-05-2011, 11:29 AM   #10
    andrea32225
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    Re: a bit of hope?

    The only imaging tests I've ever had are 2 MRI's - one each pre and post-op. Should I ask my doc to perform a nerve block or something else, especially since they did get an MED set up for me?

    I figure a 2nd appeal for a fusion is useless at this point, but if this surgery doesn't work, then I want to go somewhere else and just "start over"

     
    Old 10-05-2011, 04:42 PM   #11
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    Re: a bit of hope?

    Andrea:

    I'm sorry to be so dense, but I thought you did have a recurrent disc herniation. Didn't you reherniate the disc you had surgery on back in the spring?

    And please set me straight: Your neurosurgeon absolutely recommends fusion, right? What did he say when you were refused? Did he offer to do anything about it?

    If you want into Mayo and are willing to wait on surgery, you can call the PT department and self-request to see a doctor in that department. They will take your info and call you back in a few days after they look over the details and talk with your insurance company. If you can get in, maybe there will be some alternate treatments or ideas that come to light. It might be possible to see someone in less than 6 weeks if you give it a shot now. Just a thought -- give it a try if you're interested.

     
    Old 10-05-2011, 05:13 PM   #12
    andrea32225
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    Re: a bit of hope?

    Yes, this is the same disc on which I had surgery July 5. I haven't talked to the surgeon a bit since the denials - it's always been his secretary, and evidently he didn't tell her why the appeals didn't go through, I can understand why though after looking at what little bit I have received.

    When I finally picked up my med refills late this afternoon, I asked if they would consider doing a discogram or CT or some other imaging to try and find the source of the pain - since all the docs were gone, I figure the letter will end up in the file for him to not see until my first follow up.

    For those vets out there, how do you approach the very sensitive subject of pain mgmt? I let them know in the letter that was really my only complaint. I've been on 2 Percocet 5-325 every 6 hrs since June 1, with 2 Valium 5 every 8 hrs since July 5. I keep telling him that I'm not getting pain relief, but the Rx is always the same. Tomorrow is going to be a bad day - I rode w my angel of a friend to get the meds, so that's way too much activitiy. 2 pain pills will last 4 hrs if I'm lucky before it gets bad enough to want more.

    Ya'll all know I like this surgeon, but I just don't feel like he's concerned about my pain. I'm not looking for a huge amount of pills (I have to go every week to get them), but maybe something a little stronger and/or longer lasting)

    If this surgery doesn't work on the 20th, I am gonig to Mayo. I was told their Spine Center likes to wait 6 weeks post-surgery before seeing new patients. but I used to work there and that's where my last "real" PCP (as opposed to just looking for someone to diagnose my back) was, so I'll see what I can do...

    Good night all... the meds are kicking in and making it impossible to type a sentence without boo-boos (gotta love spell check and backspace )

     
    Old 10-06-2011, 06:53 AM   #13
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    Re: a bit of hope?

    My Boston doc was pretty anti-meds but my PA docs (moved) are actually pretty responsive to pain complaints. I really appreciate this...I think it shows a lot of concern for the patient's life beyond the OR table.


    I did have to sign a drug contract...maybe ask about that...it promised to not take meds from other docs and to cooperate in the weening off process when he says to. He noted some pharmacies like them in place before giving the big gun meds.

     
    Old 10-06-2011, 07:58 AM   #14
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    Re: a bit of hope?

    I agree with Tetonteri66 that a fusion may not solve your back pain, I think I said this before that I had a 1 level fusion because I had an extraforaminal disc herniation (repeat heniation, same level) with spondy, because I had slippage I agreed to the fusion and because of what kind of herniation it was I needed it, my surgeon did warn me that the fusion may not take care of all my back pain and he was right, I am still having back and leg pain, did have a complication which could be part of the problem, do have moderate arthritis, doctor is thinking that could be some of the problem as well. Did you ever have a mylegram? I know that gave my doctor a better picture of everything, I also had another MRI and also got the opinion from another neurosurgeon and my orthopedic doctor, just my opinion but maybe some more tests would shed some more light on things. I know it is very frustrating, I wish you the best of luck in whatever you do.
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    Old 10-06-2011, 09:05 AM   #15
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    Re: a bit of hope?

    Andrea, Maybe you should just wait on this repeat discectomy and make an appointment at Mayo. If you could avoid an additional surgery, it probably would be better for you. Every time they open you up, the chances for infection increase. I don't have any statistical proof to back up the following statement, but it seems like the more times someone is operated on at the same level, the greater the problems with scar tissue and, my one great fear, developing arachnoiditis.

    I was very blase when I had my first fusion for one level, thinking if it's not enough, they can just go back in and add on to it. I didn't realize all the information on how repeat surgeries are not a good thing, and are best to avoid, if possible.

    Why don't you see how long it would take to get an appointment at Mayo? You don't have to make a decision for a couple weeks regarding the discectomy. It sounds to me like your surgeon doesn't quite have the balance right between patient care and surgery -- he does so many surgeries that he doesn't have a lot of time left over to take care of you -- at least, that's the impression I got from comments you have made on here.

     
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