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My PCP won't refer me for specialist or authorize MRI
First I had surgery for severe nerve compression in 2021 at L4-L5.
I've been suffering from neck and shoulder pain for the last ten years or so. I've had 2 cervical epidurals and 2 facet RFAs by pain management without much relief. I was told they couldn't do anything else and might be muscle related. I've been getting botox injections in my neck without much relief.
My latest setback was about 2 weeks ago when my lower back and legs started to hurt very badly and I couldn't walk so I went to the ER. They did a CT and gave pain meds and a walker. I also had neck and shoulder pain that increased this day. I also had numbness and tingling in my feet, arm and hand.
My impression for the CT is below...
IMPRESSION:
1. BULGING DISC WITH DISC PROTRUSION AT L2-L3, MODERATELY
COMPRESSING THE THECAL SAC
2. BULGING DISC AT L4-L5, MILDLY COMPRESSING THE THECAL SAC AND
CAUSING BILATERAL SUBARTICULAR RECESS STENOSIS
3. MILD BULGING DISC AT L5-S1
My last cervical MRI was done in 2022 and these are the impressions below...
C1-C2: Normally aligned, without stenosis.
C2-C3: Partial disc desiccation, without loss of disc height, disc
herniation or spinal stenosis.
C3-C4: Partial disc desiccation, mild diffuse disc space narrowing,
and small left uncovertebral spur contributing to mild left neural
foraminal encroachment. No sign of residual posterior disc bulge.
C4-C5: Partial disc desiccation, mild diffuse disc space narrowing
and small left uncovertebral spur contributing to mild left neural
foraminal encroachment. Previously seen small central disc protrusion
is no longer seen.
C5-C6: Partial disc desiccation with interval mild diffuse disc space
narrowing and small interval central posterior disc protrusion
partially effacing the ventral subarachnoid space, without cord
compression or significant neural foraminal stenosis.
C6-C7: Partial disc desiccation with mild disc space narrowing
interval small central posterior disc protrusion partially effacing
the ventral subarachnoid space, without cord compression or neural
foraminal encroachment.
C7-T1: Partial disc desiccation, without significant loss of disc
height, disc herniation or spinal stenosis.
I was given a steroid dose pack which has helped but I'm still in pain and doing anything just makes the pain flare up. I was given a catheter by my PCP because it was extremely difficult to pee but that passed a day later thankfully.
So I currently have moderate pain in my neck, shoulders, lower back and mild pain in my legs. I have off and on headaches with sudden aches that radiate from the lower back left of my head and ear and up, partial numbness in my right hand, sharp stabbing pain on the left side of my chest, sharp pain and tingling down my left arm, sharp and dull pains off and on in my lower back and legs and tingling in my right foot.
Even with all this she won't prescribe pain meds, she won't order further testing (MRI or newer cervical MRI) or refer me to a pain doctor or to a spine surgeon (as the ER doc strongly urged). She says if I have a flareup I can see her to get a toradol injection or get it at an urgent care center if her office is closed or go to the ER if it's severe enough.
I'm at my wits end and don't know what I can do about this. I can change PCP docs but it won't go into effect until May 1st because I have to see her in early April to get my last authorization for another treatment which is very expensive.
Sorry for being so long on this post and am hoping for any advice.
Thanks!
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I, too, have (original) Medicare, but recently required a “physician’s referral” in order to see a pulmonologist.
I was told it had nothing to do with insurance.
Apparently, some ‘specialists’ doesn’t want self-referring patients.
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2 ReactionsArd you retired and on medigap? If they didn't get medigap in the 6 months around their bday, they probably can't. I try to talk to retirees about it I know I'm fortunate to even begin to afford medigap. Its not cheap and a privilege to afford it on retirement, but id give up food to pay for my medigap. And its going to keep getting more expensive as we get older. In 4 years I've gone from $130/mn to this year $180! Goes up as medical costs go up. People think medicare is free. Surprise folks. Medicare, plus medigap plus part D cost me more than $400/mn. Then the $230 medicare deductable off the top in Jan/feb. And $500 deductable for part D of the top. Affording medical insurance is a privilege. But HMO is a death trap. I waa on one my whole life as I've been 100% disabled on ssdi since I was 24. Terrible.
Know anyone retiring, you kind of only have one time in your life to get 100% medical coverage without medical clearance with medicare and a supplement. Make yourself afford it. I gave up eating out mostly but my MRI today fof a maybe broken back? 100% covered without approval needed. Dr orders. I go.
Dont get taken in with free eyeglasses instead of a CT scan. Gym membership instead of chemo. Free dental care isn't dentures and crowns. Its pull if you can find a local dentist in your plan.
Look up "medicare school" on YT. Very knowledgeable.
Ok, back to the regularly scheduled programming.
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2 ReactionsI’m with you on that. Agents push the advantage plans. I do know some folks really happy with it - but like Bebold, I’d give up eating (well, maybe not really food but I’d find something to give up) before giving up original medicare. I just changed from Plan F to Plan G to make it a bit more affordable for now. No different except the one time $250 deductible.
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1 ReactionAny more tips for Medicare? I’m doing my research early. I’ll need supplies for T1 diabetes insulin pump and have complex, nondiabetic eye conditions. I plan to work to age 70.
I have a Medigap supplement policy --- it costs me $222.00 per month. I would never ever consider going on Medicare Advantage. Number One, because I have a lot of chronic conditions and my utilization is High. Medicare Advantage is really only for those people who are in Excellent health and not heavy utilizers of their health plan and benefits. I am a heart patient and a diabetic, I'm on a lot of medications also. Regular Medicare does just fine for me with a Medigap policy, but as was previous said these Premiums for Medigap policies will continue to increase every year .....the goal is to force people to go on Medicare Advantage.
I've run into situations like that, but it was the preference of the clinic, provider or office I was contacting that preferred a formal referral. They were usually specialists that had a very narrow focus. (I am on private insurance and help my parents often with Medicare.)
Traditional Medicare doesn't require a referral, but I suppose the system, clinic, or provider might "require" one? Either way, that is frustrating.
I was admitted to the hospital and had MRI's done a couple weeks ago. I had a consult with a neurosurgean at the hospital that said I don't need surgery now. They did labs that showed I had extremely severe inflammation. I was given very large doses of steroid anti-inflammation meds via IV throughout my stay. They had to constantly give me insulin due to this even though I don't have diabetes.
They did a ton of labs for auto immune disorders which all came back good. They still think it's some disorder causing excessive inflammation throughout my body they just don't know what.
I'm getting physical therapy now while waiting for my PCP visit to figure out the next steps. It's very interesting that within one week my inflammation is jumping back up again and my WBC, RBC, etc are going abnormal again without "any" symptoms of illness.
I know I'll be seeing specialists but I don't know which type yet until my visit. I wanted to give you all an update and show my support for all the advice provided even though I've been unable to contribute much here yet.
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