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  • 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
    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 63, the new 64...
    Pre surgery curves T70,L70
    ALIF/PSA 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

    Comment


    • #3
      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

      Comment


      • #4
        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 63, the new 64...
        Pre surgery curves T70,L70
        ALIF/PSA 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

        Comment


        • #5
          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

          Comment


          • #6
            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.

            Comment


            • #7
              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 63, the new 64...
              Pre surgery curves T70,L70
              ALIF/PSA 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

              Comment


              • #8
                FLT-- YAY! Keep us posted!
                71 and plugging along... but having some problems
                2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
                5/4/07 posterior fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
                Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

                Corrected to 15°
                CMT (type 2) DX in 2014, progressing
                10/2018 x-rays - spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

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

                Comment


                • #9
                  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.
                  Fused T-3 to L-3, Aug 25
                  Hardware removal surgery, Nov 2, 2010
                  Fused T-10 to L-2, osteotomy, Feb 22, 2011

                  Comment


                  • #10
                    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

                    Comment


                    • #11
                      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.

                      Comment


                      • #12
                        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

                        Comment


                        • #13
                          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?
                          Fused T-3 to L-3, Aug 25
                          Hardware removal surgery, Nov 2, 2010
                          Fused T-10 to L-2, osteotomy, Feb 22, 2011

                          Comment


                          • #14
                            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

                            Comment

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