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Thread: Insurance...ugh

  1. #1
    Join Date
    Dec 2008
    Location
    Huxley, Iowa
    Posts
    190

    Insurance...ugh

    Does anyone have any tips on working with your insurance company? Mine has put up roadblocks just about every step of the way. I was all set to go to the Twin Cities Spine center for a second opinion on the 25th. Instead, my insurance decided that it was unnecessary and refused to pay for it. According to them, because I have had a "fusion revision" in Iowa before, with the surgeon who is considered to be "the best in the state", I should go back to him for a second opinion, instead of going out of state. I am beyond frustrated.
    They suggested if I did not want to get a second opinion from the surgeon who did my original fusion and the revision, that I go elsewhere locally. Unfortunately I saw many of the doctors in all of the orthopedic centers in Central Iowa before I had my fusion, and they sent me to the one I had my fusions with.

    I have talked to customer service, supervisors, nurses, patient advocates, and others, and the insurance is NOT budging on this. Apparently they would approve the Mayo Clinic, but not the Twin Cities Spine Center.

    Any ideas?
    25 years old
    double 70+ degree curves before surgery
    Anterior on 11/11/08
    Posterior on 12/2/08 with titanium rods
    nearly perfect correction
    fused t-10 to pelvis
    with a hemi-vertebral osteotomy at L4

    Broke right rod at L4-L5 on 06/26/09
    Broke left rod on 10/24/09
    Revision surgery on 11/5/09 with vitallium rods
    Broke both rods again

    Had posterior than anterior revisions on 03/11 at the Twin Cities Spine Center
    Declared "FUSED" on 12/6/11

  2. #2
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,534
    Fierce

    I would call Twin Cities on the phone and ask them what to do. They will have someone who knows how to handle this.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  3. #3
    Join Date
    Dec 2008
    Location
    Huxley, Iowa
    Posts
    190
    Yup, tried that. They said that they can't help me at all.
    25 years old
    double 70+ degree curves before surgery
    Anterior on 11/11/08
    Posterior on 12/2/08 with titanium rods
    nearly perfect correction
    fused t-10 to pelvis
    with a hemi-vertebral osteotomy at L4

    Broke right rod at L4-L5 on 06/26/09
    Broke left rod on 10/24/09
    Revision surgery on 11/5/09 with vitallium rods
    Broke both rods again

    Had posterior than anterior revisions on 03/11 at the Twin Cities Spine Center
    Declared "FUSED" on 12/6/11

  4. #4
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,534
    Why don’t you go talk to the people at the Mayo clinic since the insurance company approves.... I was looking at their website and they do have 50 adult orthopedic surgeons.

    Its worth a shot. They do have one heck of a reputation there.......and of course they do scoli surgeries there along with some pretty difficult procedures.

    It sounds like you don’t have much choice in this, and with broken rods, maybe you shouldn’t wait. Sounds very painful.
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
    Join Date
    Dec 2008
    Location
    Huxley, Iowa
    Posts
    190
    Actually, I just got a call from my insurance saying that after "many phone calls" from my primary care physician they will be approving the visit to the twin cities! I am so excited its ridiculous. :-P
    25 years old
    double 70+ degree curves before surgery
    Anterior on 11/11/08
    Posterior on 12/2/08 with titanium rods
    nearly perfect correction
    fused t-10 to pelvis
    with a hemi-vertebral osteotomy at L4

    Broke right rod at L4-L5 on 06/26/09
    Broke left rod on 10/24/09
    Revision surgery on 11/5/09 with vitallium rods
    Broke both rods again

    Had posterior than anterior revisions on 03/11 at the Twin Cities Spine Center
    Declared "FUSED" on 12/6/11

  6. #6
    Join Date
    Jan 2009
    Location
    Ames, Iowa
    Posts
    1,250
    That's fantastic! I hope you can get in soon. You've been through enough. Good luck. Janet
    Janet

    61 years old--57 for surgery

    Diagnosed in 1965 at age of 13--no brace
    Thoracic Curve: 96 degrees to 35 degrees
    Lumbar Curve: 63 degrees to 5 degrees
    Surgery with Dr. Lenke in St. Louis--March 30, 2009
    T-2 to Pelvis, and hopefully all posterior procedure.

    All was posterior along with 2 cages and 6 osteotomies.

  7. #7
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,534
    Fierce

    Great news. Glad you didn’t have to wrestle with the insurance company.

    Be sure to update us. It will be interesting to see why you are not fusing.
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  8. #8
    Join Date
    Oct 2007
    Location
    Indiana
    Posts
    1,974
    FLT-- YAY! Keep us posted!
    66 and still heartbroken...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
    2014 DXd w/CMT (type 2)

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  9. #9
    Join Date
    Jun 2009
    Posts
    311
    At long last!! I am so glad to hear that this particular frustration has been taken care of. I wish you well. . .this all has to be very wearing.

  10. #10
    Join Date
    Dec 2008
    Location
    Huxley, Iowa
    Posts
    190
    Thanks everyone, I had my first visit at the Spine Center today. They were amazing. I have a CT myleogram on Friday morning. It now looks as though there has been very little fusion at all. There are at least 2 other non-unions that are showing very little to no growth. We will know more on Friday, but it appears that I'll be having both an anterior and posterior revision.
    After discussing all of the activity recommended after the first fusion, it was the opinion of the surgeon I saw today that it did not cause the non-union, since I am not showing fusion after 2 years, but that it did hasten the breakage. He said if I had sat on the couch a lot I might have had a few years before it broke, but it would have eventually broken, since I am just not fusing.
    25 years old
    double 70+ degree curves before surgery
    Anterior on 11/11/08
    Posterior on 12/2/08 with titanium rods
    nearly perfect correction
    fused t-10 to pelvis
    with a hemi-vertebral osteotomy at L4

    Broke right rod at L4-L5 on 06/26/09
    Broke left rod on 10/24/09
    Revision surgery on 11/5/09 with vitallium rods
    Broke both rods again

    Had posterior than anterior revisions on 03/11 at the Twin Cities Spine Center
    Declared "FUSED" on 12/6/11

  11. #11
    Join Date
    Jan 2009
    Location
    Ames, Iowa
    Posts
    1,250
    Fierce--
    I'm so glad that you are now in good hands. What a difficult journey for you. Their answers do explain a lot. I hope they can schedule you soon for your revision and you can begin to really heal! Janet
    Janet

    61 years old--57 for surgery

    Diagnosed in 1965 at age of 13--no brace
    Thoracic Curve: 96 degrees to 35 degrees
    Lumbar Curve: 63 degrees to 5 degrees
    Surgery with Dr. Lenke in St. Louis--March 30, 2009
    T-2 to Pelvis, and hopefully all posterior procedure.

    All was posterior along with 2 cages and 6 osteotomies.

  12. #12
    Join Date
    May 2008
    Location
    Central NJ
    Posts
    1,956
    Quote Originally Posted by fierceliketiger View Post
    Thanks everyone, I had my first visit at the Spine Center today. They were amazing. I have a CT myleogram on Friday morning. It now looks as though there has been very little fusion at all. There are at least 2 other non-unions that are showing very little to no growth. We will know more on Friday, but it appears that I'll be having both an anterior and posterior revision.
    After discussing all of the activity recommended after the first fusion, it was the opinion of the surgeon I saw today that it did not cause the non-union, since I am not showing fusion after 2 years, but that it did hasten the breakage. He said if I had sat on the couch a lot I might have had a few years before it broke, but it would have eventually broken, since I am just not fusing.
    Do they know why you haven't fused both these times? And what can they do to ensure that you fuse nex time?

    I'm so sorry that you are having all this trouble.
    __________________________________________
    Debbe - 50 yrs old

    Milwalkee Brace 1976 - 79
    Told by Dr. my curve would never progress

    Surgery 10/15/08 in NYC by Dr. Michael Neuwirth
    Pre-Surgury Thorasic: 66 degrees
    Pre-Surgery Lumbar: 66 degrees

    Post-Surgery Thorasic: 34 degrees
    Post-Surgery Lumbar: 22 degrees

  13. #13
    Join Date
    Jun 2009
    Posts
    311
    It sounds like we are walking a similar path. I will be very interested to see if the surgeon has a possible explanation for why you are not fusing, and what he plans to do differently with the next surgery to make sure that the same thing doesn't happen again. (These are the questions that my husband is anxious to have answered, regarding me, before I have "try at fusion, part 2".)

    I am so very happy that you are now in good hands, and that the ball can get rolling. Did this doctor address the question of pain management?

  14. #14
    Join Date
    Dec 2008
    Location
    Huxley, Iowa
    Posts
    190
    We did discuss pain management a little, and they think that it might be an additive or chemical binder that I am allergic to, since I am allergic to the pill form of some other meds, but because some of the reaction is breathing, he is reluctant to prescribe the liquid form of the pain meds because I live so far away. He did say that he thinks I should go back to my primary care dr and discuss it with her.

    They won't really know why it hasn't fused until tomorrow's CT, but I will update as soon as I know

    mgs, my husband is very interested in the answers too. He is an engineer, so he has a ton of technical questions for the doctors regarding load bearing and all of that. However, on this trip he had to stay home to save up some vacation time for what appears to be a much larger, more intense surgery than we anticipated for revision number 2
    25 years old
    double 70+ degree curves before surgery
    Anterior on 11/11/08
    Posterior on 12/2/08 with titanium rods
    nearly perfect correction
    fused t-10 to pelvis
    with a hemi-vertebral osteotomy at L4

    Broke right rod at L4-L5 on 06/26/09
    Broke left rod on 10/24/09
    Revision surgery on 11/5/09 with vitallium rods
    Broke both rods again

    Had posterior than anterior revisions on 03/11 at the Twin Cities Spine Center
    Declared "FUSED" on 12/6/11

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