F'N insurance companies...

LATS · Feb 25, 2012

well found out i have to have surgery on my c6.. it is "collapsed" and impinging the nerve and spinal cord.. my doc wants to do a disc implant.. he says that being as i am only 43 and active he does not want to fuse the disc.. my insurance company says "no".. they say it is experimental and they only will pay for fusion.. yet, the implant was approved in 2006 by the fda.. so i now have to go with a appeal which could take 2-3 weeks.. in which i cant lift anymore until the surgery and my arms and hands going numb and shocks of pain down my arms and shoulders..

but yet i have two people at work that have had disc replacement and are not active or had any issues with insurance :banghead:.. my rant is now over lol

maldorf · Feb 25, 2012

Wow, I feel for you. There really isnt a damn thing you can do. I hope that the appeal works. How does the cost of the disc implant compare to the fusion surgery? Is it a much more costly procedure. Im lucky I didnt run into any shit when I had my heart attack.

Styles · Feb 25, 2012

I feel you Lat.I have spinal stenosis and my l4,l5 is closing in on my spinal cord and is making my legs go numb.It is also causing problems with my piriformis.I have had 5 injections 2 to the spine,2 to the s1 and one into the piriformis.I go to my checkup this last monday and the back doc told me that insurance did not cover the injections because it is experimental.Now 800 dollars each injection later im told this.Here is what pisses me off the most,insurance told the doc if it was back surgery they would have covered it.Im doing the inj to try and put off surgery for a little while.Now im waiting on a nice bill to come.

beggar · Feb 25, 2012

LATS said:
well found out i have to have surgery on my c6.. it is "collapsed" and impinging the nerve and spinal cord.. my doc wants to do a disc implant.. he says that being as i am only 43 and active he does not want to fuse the disc.. my insurance company says "no".. they say it is experimental and they only will pay for fusion.. yet, the implant was approved in 2006 by the fda.. so i now have to go with a appeal which could take 2-3 weeks.. in which i cant lift anymore until the surgery and my arms and hands going numb and shocks of pain down my arms and shoulders..

but yet i have two people at work that have had disc replacement and are not active or had any issues with insurance :banghead:.. my rant is now over lol

I wanted to get the same thing done when I was in the military. Disk replacement is standard in the UK and covered by insurance. For some reason they are always ahead of the US in getting things approved.

The Beggar

JOEY11 · Feb 25, 2012

what ins do you have if you don't mind? i have aetna and i had an issue with some tests when i was in for my liver resection and our company has a health advocate that goes to bat with the ins company and got them approved. i don't know if that would change anything in your case, just some info.

i have c5-c6/c6-c7 herniated discs but luckily with a pt and stretching and a foam roller it's rehabbing, but i'm sure will show up again later and i'll have to have surgery. my right pec has atrophied and i lost 40% strength in pressing movements

IPGear · Feb 25, 2012

LATS said:
well found out i have to have surgery on my c6.. it is "collapsed" and impinging the nerve and spinal cord.. my doc wants to do a disc implant.. he says that being as i am only 43 and active he does not want to fuse the disc.. my insurance company says "no".. they say it is experimental and they only will pay for fusion.. yet, the implant was approved in 2006 by the fda.. so i now have to go with a appeal which could take 2-3 weeks.. in which i cant lift anymore until the surgery and my arms and hands going numb and shocks of pain down my arms and shoulders..

but yet i have two people at work that have had disc replacement and are not active or had any issues with insurance :banghead:.. my rant is now over lol

Damn bro,

Cant even beat off, we mean lift! This to shall pass. If theres a medical attorney that is more effective at presenting these appeals, let us know we would be happy to help.

You know we gots to have the protection of you mods as its all about the money.

For you old friend we will always try to help where we can.

IPG

triathloncoach · Feb 25, 2012

I think it's the damn doctors who do too much unnecessary spinal surgery. The WSJ constantly profiles criminal surgeons who perform multiple surgeries on people who don't need, or benefit from them. These surgeons make millions a year on unnecessary operations. And so do the hospitals who allow these crimes to occur. Google this scam.

So because of this 1% of crooked surgeons and hospitals, profit only driven insurance companies are given, and thus of course take advantage of this opportunity to block legitimate operations.

LATS · Feb 25, 2012

it is blue cross.. we have a appeal going right now.. my doc is new to the area from hardvard medical.. has done numerous one with this exact implant.. the surgery runs 43,000 grand.. the fusion runs anywhere from 32,000 to 36,000.. not much different really.. just silly really.. after the appeal we will get lawyers involved.. but am getting a bit worried by all the delays that i might be doing more permanent damage.. of course, i am sure this is whatthe insurnace companies are hoping for.. me gtting antsy and going ahead with the fusion..

thanks ip.. ill let ya know.. i appreciate what you have helped with in the past..

raskan · Feb 25, 2012

wrong thread sorry

raskan

maldorf · Feb 26, 2012

LATS said:
it is blue cross.. we have a appeal going right now.. my doc is new to the area from hardvard medical.. has done numerous one with this exact implant.. the surgery runs 43,000 grand.. the fusion runs anywhere from 32,000 to 36,000.. not much different really.. just silly really.. after the appeal we will get lawyers involved.. but am getting a bit worried by all the delays that i might be doing more permanent damage.. of course, i am sure this is whatthe insurnace companies are hoping for.. me gtting antsy and going ahead with the fusion..

thanks ip.. ill let ya know.. i appreciate what you have helped with in the past..

Wow, yeah just a $7 k difference in price is nothing to these giant companies. Is the $43k the price before the insurance company gets the reduced rate or is that the price before? For instance, my first stay in the hospital with the heart attack was about $135,000 and insurance only paid them about $75,000. That was back when insurance was good and we had to only pay $500 for a hospital admission!!! The contracted price deals the insurance companies arrange are almost 1/2 price and so if the $45k price you mention is before the contract then you can bet it will only cost the insurance company maybe $30k tops.

cat1wannabe · Feb 26, 2012

That is just stupid, and scary since I have BCBS also.

LATS · Feb 26, 2012

MALDORPH I WISH I COULD TELL YA.. the info i got was from the dr nurse who gave us costs of the two procedures.. the thing that pisses us off is the whole "experimental" bs.. it was approved in 2005.. even when told that to the physcian at the insurnace company they still said "experimental"..

MindandBody · Feb 26, 2012

I couldn't imagine how much that must suck...Good luck with everything!

thebrick · Feb 26, 2012

damn Lats, I hate that. Maybe with some fuss on the appeal they will come through on this procedure fro you.

I dealt with the exact same problem last year. I am quite a bit older though and I had the fusion done at C4-C6. I have been very happy with the result. No more pain, tingling, weakness in that left arm and i am training like old times. I know a guy at the gym that had a one level fusion when he was younger and has done well with no issues since

The key to a good outcome is just get it corrected without waiting a long time. I hope you can get the implant, but the fusion is not a terrible option either

MrDeflation · Feb 26, 2012

is this all insurance companies or do you think its just Blue Cross/Blue shield that would do this?

LATS · Feb 26, 2012

deflation... from what i understand it can be all companies.. hear this from others that have various insurance companies and some do and some dont..

maldorf · Feb 26, 2012

LATS said:
MALDORPH I WISH I COULD TELL YA.. the info i got was from the dr nurse who gave us costs of the two procedures.. the thing that pisses us off is the whole "experimental" bs.. it was approved in 2005.. even when told that to the physcian at the insurnace company they still said "experimental"..

Doesnt make much sense if the FDA has approved it then it has been deemed safe and effective I would think. It is in their best interest to get you back to health otherwise youll rack up more costs without the right surgery I would think.

mmll3219 · Feb 26, 2012

BC/BS is notorious for not approving the disc replacement surgery. An appeal does work some times though. The real kicker is the hundreds of thousands of dollars that they will dump into patient care for people in the ICU that will never wake up or improve but the family wants "everything done no matter what", yet there are tons of people like you that will be tremendously more functional and have a hugely improved quality of life that they make jump through hoops.

maldorf · Feb 26, 2012

mmll3219 said:
BC/BS is notorious for not approving the disc replacement surgery. An appeal does work some times though. The real kicker is the hundreds of thousands of dollars that they will dump into patient care for people in the ICU that will never wake up or improve but the family wants "everything done no matter what", yet there are tons of people like you that will be tremendously more functional and have a hugely improved quality of life that they make jump through hoops.

Gotta watch that kind of thinking. Youre starting to sound like a politician making choices of who gets health care and who doesnt. Not a good thing.

mmll3219 · Feb 26, 2012

I'm just saying they dump tons of $ into ICU patients without requiring any evidence that any of these ridiculously expensive therapies have a true benefit (although this is starting to change). Yet there are other surgeries and so forth that would benefit people that insurance companies make it so difficult to get approved.

I'm not saying they should ration care, I'm just saying that everything should have generally have evidence-based support for using it. That and drug companies should not be able to charge ridiculous amounts of $ for certain medications. There are people getting the equivalent of a BMW 7 series in meds every month that don't really have a true proven benefit.