Need your help- buzzwords

Posted by denheels @denheels, Mar 31 10:54am


I've had 2 ACDFs (5-7) and the rest of my spine is crumbling. Prior to the cervical issues, I already had l5-s1 issues (active lifestyle, various injuries throughout life). 2 areas in thoracic are now in trouble.

The problem is my new-this-year insurance company denies every request for new imaging. My pcp's office is useless. They create work for me instead of solving problems and navigating their own industry for me. My surgeon is excellent but that office won't help until it's time to cut.

I need some fresh ideas as to what to say when I call. I threatened to sue my last insurance provider when they held up my 2nd ACDF, hence the change.

I can just wait and go to urgent care or the ER but I would rather not do that. It's been a long 2 years...

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How frustrating this must be. I'm curious if you've been told you have degenerative disc disease (DDD) which is essentially arthritis of the spine. It can do a lot of damage. These days, you would have to have some severe nerve compression before surgery is recommended. And those would create some pretty impressive symptoms like weakness. But getting some imaging might at least get you a prescription for physical therapy and the like.
Typically with the spine, there is a correlation of symptoms with the affected nerve roots. Try looking at a dermatome diagram. That indicates which nerve roots serve which areas of the body and where you would feel symptoms. I've looked at that with my cervical or lumbar areas. I don't know what symptoms someone would have with thoracic nerve roots though. You might have to look that up. It's also possible to get adult onset scoliosis from DDD. To pickup "buzzwords" you can try adding google scholar at the end of what you are searching in the search bar. That will bring up medical articles. But many of these can be difficult to interpret without some medical terminology knowledge. But between the process of reading and looking up terms, you may surprise yourself with what you can learn. I wish you luck.


@denheels It might be effective to be more specific about your symptoms, specifically where you feel pain or weakness and what is your body position when you feel it? Does it come and go or stay constant? What type of pain is it? Numbness, tingling, burning, electric shocks? Does it interrupt your sleep? Are these new symptoms and when did it start?

From your description of "crumbling" I begin to imagine compression fractures, and perhaps that isn't correct. Thoracic areas in trouble could mean many different things.

Do you have a report from your most recent spine imaging?

I think your insurance needs to justify expense for further imaging, and that will only come from your doctor's recommendation. The doc needs to diagnose or request tests based in your symptoms. Perhaps writing a message to your doctor may initiate an appointment and a conversation.



Well since your problem is getting imaging done that means MRIs. If you are talking about problems with the thoracic area I would wonder if with your problems you might first get some of the other tests that would almost force the insurance company to approve them. If you are having more than just pain in your neck how about getting your PCP to refer you to a neurologist if you have any nerve problems you might be experiencing because of cervical problems? For me, one of the problems I have are fingers that tingle. Neurologists can order EMGs and MRIs by getting insurance authorization but PCPs usually even have a hard time ordering an EMG which for them might be the only way for them to possibly get an MRI of the spine w/out a neurologist. HMOs are difficult and depending on who your PCP can refer you to is always the next step. I hope that helps in some way take care


@denheels. Sorry for your insurance difficulties. Let me take a different approach in making some suggestions on how to deal with the company.

Insurance companies are often in the business of first saying, "No. Show me your need." This is aggravating but merely a common practice and says nothing about what they will ultimately agree to...

By starting with a "no", commonly, insurance companies are also a bit immune to threats and "I'm going to sue you", sorts of comments. What is useful to understand is that they have a very well-developed system for handling complaints. (They all do). My recommendation is to do these things: (1) Arm yourself with detailed information about your current condition and why you believe you need an MRI. (as an aside - what's with your PCP? They should be very willing to Rx an MRI as it's nothing to them...?) (2) Call (no emails or letters) and share your information with whoever answers the phone. (3) If you get "no" - ask for that person's supervisor and phone number. Then repeat step #2. (4) If still "no" - keep working up the line.

Supervisors have less time and patience in dealing with these sorts of calls. They also have more authority to make exceptions. The higher up you go - the less time they have for your specific complaint and the more they want to just move on.

Ultimately, you can reach out to the CEO. (I'm serious). Be creative and send an email or call the CEO's office and you'll ultimately get to the person guarding the CEO's front door. Now you've reached the place where the person can really help you out as they DON'T want the CEO to get contacted by your issues.

I know - it's time-consuming and irritating and should be easier for the customer...but that's just the way of the insurance world.

Best of luck. BTW - How much does an MRI actually cost the insurance company?

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