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Insurance Denial - So Depressed

I was scheduled to have a L4/L5 Laminectomy
Transforaminal Lumbar Interbody Fusion and Posterior Segmental Instrumentation today actually.

I received a call from my surgeon's office yesterday afternoon saying that my surgery would have to be rescheduled because they didn't get approval for everything.  They tentatively rescheduled it to August 29th, and set up a peer - to - peer review with my insurance company for this morning.

I talked to my insurance company, and they said that the peer to peer review resulted in having some of the procedures approved and some are still denied.  I don't really know what was approved or denied, but I think the Laminectomy part was approved, and I don't think the Fusion part was.

I'm so upset, so frustrated, so depressed.  I was supposed to be recovering from surgery right now.  I shouldn't be working today.  I was mentally and physically prepared, everything was set, and all the people in my life knew about it. 

I still have to wait for the doctor's office to call and tell me what's going on.  After the peer-to-peer review, they could still appeal, but I don't know if that's a viable option, or if it would even matter. 

I've been crying pretty much non-stop since this morning.

Jessica

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Comments

  • RDavidGRRDavidG Jacksonville FlPosts: 7

    Jessica, only thing I can say is hang in there! Dealing with insurance companies are sometimes worst then the procedure! Give it time. It will work itself out!

  • Thanks David.  I sure hope you're right!!!

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  • Hi  Jessica

    I am so sorry to find this message and feel your terrible upset.

    I know this doesn't seem much at the moment but I can see you have put the your team could appeal this and I can only hoe for positive outcome from that.

    I find it incredible that you can get to the day before your surgery and the insurance company can deny treatment at such a late stage.  I am in the UK so do not understand how that can deemed possible on that timescale.  We have very long waiting lists and cancellation obviously, but this is different.

    I feel from your comments that your medical team are behind you and that is the positive here.

    lots of comfort hugs coming your way.

    Take care

    AJ

    AJGormit

    ---------------------------------------------------------------

    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
  • Thank AJ.  I think the problem for me was that they scheduled the surgery before getting insurance approval.  Usually there is no problem, but for me the insurance had additional questions, i didn't meet their requirements, and we can only hope that an appeal will work.  I wish i knew exactly what the denial is for, so i can maybe address the concerns or at least understand why i'm ineligible. 

  • Do your medical team not have that information to give you?

    Posted something on August group for you

    AJ

    AJGormit

    ---------------------------------------------------------------

    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
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  • Just talked to the doctor's office, she doesn't have any information from the insurance company.  The surgeon did the peer-to-peer review this morning but he's in the hospital today (doing surgeries, just not mine) so she's going to talk to him tomorrow and come up with a plan.

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