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jackieg412
01-12-2014, 06:08 PM
I HAVE A QUESTION.
Is the disc between c-7 and t-1 considered cervical or thorasic?? I am in an argument with the insurance company about the matter. If it is cervical --they will not pay for the epidural the doctor ordered at that level. If it is thorasic--I may be able to get it payed for by them. What to do==I really thought it was both.
Sometimes it makes you wonder who is in charge and WHY??? is it so hard to get an approval for care??Anyone know which it is?
Help Please!

LindaRacine
01-12-2014, 07:59 PM
I HAVE A QUESTION.
Is the disc between c-7 and t-1 considered cervical or thorasic?? I am in an argument with the insurance company about the matter. If it is cervical --they will not pay for the epidural the doctor ordered at that level. If it is thorasic--I may be able to get it payed for by them. What to do==I really thought it was both.
Sometimes it makes you wonder who is in charge and WHY??? is it so hard to get an approval for care??Anyone know which it is?
Help Please!

That seems totally ridiculous. There's no answer to the question. I would ask the physiatrist to ask for a peer-to-peer review with the insurer.

--Linda

LindaRacine
01-12-2014, 08:21 PM
I just read the full issue on another thread. Having WC in the issue changes everything, though you may still need your doctor to work with your case worker.

jackieg412
01-14-2014, 05:02 PM
Thanks Linda for your reply. It is a WC issue. I have my lawyer invoved in it also. I keep trying to move it forward. I have waited since Dec.5 no answer as of yet. I had to get the WC rejection before my medicare would pay. It is one phone call after another and no answer yet .Can anyone say if that disc is thorasic or cervical or is just both?

leahdragonfly
01-14-2014, 08:49 PM
Hi Jackie,

I think anatomically it is cervical. Each disc is described in relation to the vertebrae it is under I believe. So I think the disc between C7-T1 is called C7's disc. Also, the injections are not into the disc but into the nerve roots, so in that case it would be the C7 nerve roots being injected.

Best of luck with this. I can't imagine how aggravating this is for you.

LindaRacine
01-14-2014, 08:50 PM
I've never heard or seen discs numbered anything other than a combination of the vertebra above and the vertebra below.

Pooka1
01-14-2014, 08:55 PM
How do these WC people sleep at night after dealing with people in need of pain relief in such a callous an frankly idiotic manner? This is ONE spine. Just because one part gets injured doesn't mean that can't have ramifications to other parts. It should be beneath them to do this to another person.

susancook
01-15-2014, 02:04 AM
I HAVE A QUESTION.
Is the disc between c-7 and t-1 considered cervical or thorasic?? I am in an argument with the insurance company about the matter. If it is cervical --they will not pay for the epidural the doctor ordered at that level. If it is thorasic--I may be able to get it payed for by them. What to do==I really thought it was both.
Sometimes it makes you wonder who is in charge and WHY??? is it so hard to get an approval for care??Anyone know which it is?
Help Please!

Jackie: it is my understanding that payment is contingent on: ICD9 diagnosis and procedure/treatment that fits the code. Most of the time, pre authorization is required. Do you know how your doctor billed for services? Susan...medical billing paperwork is always a bitch

jackieg412
01-15-2014, 01:38 PM
Hi to my Friends
All of your help is good for me---it might not change anything but it is good support for me. about my WC case --it is settled with open medical until the insurance company can fund a medicare set aside dollar amount. They have had since last July to do so. no money yet for me--so the law says they pay. and they don't want to do that --so they fight. All along the insurace company has agreed to pain control and I think the epidural is for PAIN.But it is not approved. I do not know how the doctor visit was billed to them but I do have the codes for the epidural. As Follows:
Thorasic back pain{315256}.neck pain{138037}
comments:epidural injection x 2 for cervicothorasic pain.
The pain doctor diagnosisis coded 723.9 and several other codes are there as well.
We all know it is not unusual to have a problem with these long fusions and I only have this one disc as I am fused c5,6,7 and then t1-pelvis. This poor disc takes a lot!
I am trying to have it done through my medicare,but I needed Wc to say no{and they did} and My spine doctor is not accepting my form of medicare as of 12/31/2013.
It is a very big issue.

LindaRacine
01-15-2014, 09:26 PM
How do these WC people sleep at night after dealing with people in need of pain relief in such a callous an frankly idiotic manner? This is ONE spine. Just because one part gets injured doesn't mean that can't have ramifications to other parts. It should be beneath them to do this to another person.

I have no love for WC employees, but they have to deal with a huge amount of fraud. So, I think they're essentially being forced to overreact to everyone. It's truly unfortunate that some horribly dishonest people are responsible for making millions suffer.

jackieg412
01-18-2014, 03:46 PM
Yes Linda is right-- the workers comp employees can be difficult. I know that FRAUD is the main issue or at least their main issue when denying treatment. I have had 5 different adjustor's during my very long 6 years. Two of them were OK and the other 3 made every part of this long journey a trial.I know the idea is to wear the patient out. I still wonder way it is so very difficult.
My hard part is the injury was complicated by the fact I had scoiliosis. And scoliosis complicates a lot of areas of the spine. And each area has an effect on the other one . Then the legal system gets involved and trys to make it all seam unnecessary treatment. It is expensive but you can't really call it unnecessary.
I am waiting for what is called a MSA{medicare setaside agreement}Medicare is refusing to pay because workers comp is to pay ---and right now everyone is saying the other is responsible. And I have to wait it out. I have been doing this since last July---waiting that is. When the MSA is funded--I will have a trust fund of money to pay medical expences with{relating to injury and surgery}. At least then I will not have to deal with the adjustors for the insurance company.I just have to keep very good records.
So I am still waiting .
I hope to know this week about the epidural. That is if medicare approves it.

jackieg412
02-13-2014, 04:00 PM
Epidural update--
It is now Feb 13 and still no approval for epidural The dr ordered it on Dec 5.I am awaiting a call from my medicare{HMO} . it is to take place tomorrow--I have seen all people needed for a referral that is needed and the insurance company has not given approval. They are to call back in the next hour or it has to be cancelled for tomorrow. WHY is this so difficult????
I needed to change primary doctors,I did that, I got the new doctor's OK last week, I got on the schedule to have injection and need the approval of the insurance--and it is being delayed. I was really counting on it--I had a driver in place-- made all arrangments--and found out today that it had not been approved. WHY? WHY? WHY? Since it has been like this all along for me--I just need to accept that everything will be difficult.Happy Valentine's day to all!!

ScoJo
02-24-2014, 09:28 AM
Epidural update--
It is now Feb 13 and still no approval for epidural The dr ordered it on Dec 5.I am awaiting a call from my medicare{HMO} . it is to take place tomorrow--I have seen all people needed for a referral that is needed and the insurance company has not given approval. They are to call back in the next hour or it has to be cancelled for tomorrow. WHY is this so difficult????
I needed to change primary doctors,I did that, I got the new doctor's OK last week, I got on the schedule to have injection and need the approval of the insurance--and it is being delayed. I was really counting on it--I had a driver in place-- made all arrangments--and found out today that it had not been approved. WHY? WHY? WHY? Since it has been like this all along for me--I just need to accept that everything will be difficult.Happy Valentine's day to all!!

Jackieg412,

I hope this has since been worked out. I feel for you as I know how the bureaucracy of insurers can wear the most diligent person to the bone. The outrage is when you sick and no energy to give the fight.

Hang in there.

Scojo

jackieg412
02-24-2014, 12:44 PM
I did have the epidural on Monday the 17th. It was a rough one for sure. They used a different name for it. Maybe because of the level at c7 _t 1.It actually really hurt down my left arm. I do mean hurt. I spoke to the Dr and will see him on Friday. We are supposed to do another one.I can't say this one helped. It did give me energy.

jackieg412
03-01-2014, 07:58 PM
I saw the dr on Friday--we are going to try another epidural for the upper thorasic pain--the first one didn't help too much but I will try another one. I know that we are just buying more time as I do not want to add to the fusion right now. Everything says that the disc is not holding up--but maybe we can keep me comfortable for awhile.
Has anyone heard of a hardware block?? The hardware at the junction of my 2 surgeries is giving me problems and the doctor talked about doing a hardware block.Anyone had one??

titaniumed
03-01-2014, 11:02 PM
Jackie

I guess he is trying to rule out hardware related pain problems...
http://advancedpaincenters-org.securec48.ezhostingserver.com/wp-content/uploads/2013/02/HARDWARE-INJECTION.pdf

I know about the C6-C7 level arm pain.....last year with my diagnosed cervical herniationís it felt like someone punched me in my arm really hard. I also had finger numbness.

Ed

LindaRacine
03-02-2014, 12:29 PM
Jackie

I guess he is trying to rule out hardware related pain problems...
http://advancedpaincenters-org.securec48.ezhostingserver.com/wp-content/uploads/2013/02/HARDWARE-INJECTION.pdf

I know about the C6-C7 level arm pain.....last year with my diagnosed cervical herniationís it felt like someone punched me in my arm really hard. I also had finger numbness.

Ed
I'm shocked to see that anyone does these injections with fluoroscopy. If the hardware is the problem, the area is painful when it's palpated. As far as I know, most do these injections in clinic. The difference in cost is probably somewhere in the neighborhood of $1,000-$2,000.

--Linda

rohrer01
03-02-2014, 01:42 PM
While I haven't had any cervical injections, yet. ALL of my other injections are done under fluoroscopy. I'm not chancing anyone going near my spine and nerves with a needle and not actually seeing where they are.