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Spinal Fusion Denied

Started by Suzyhomebaker on 07/18/2017 11:08pm

Hi,
This is my first time posting it as I am new here. I'm at a complete loss for words, I just found out today that my final attempt to receive a spinal fusion has been denied. I have been going through this for the last two years fighting Blue Cross Blue Shield of Illinois with multiple internal appeals as well as external reviews. I found her three spinal specialists who all agree that I would benefit from the spinal fusion. My primary specialist has done 2 peer to peer's with the insurance companies doctors. No one seems to care that I am in excruciating pain and that I have limited mobility on a daily basis. I am a mom of five kids ranging from 4 to 15 years old. As I sit here and type this, i'm crying because I'm realizing this was my last opportunity to get my life back and feel normal again. I tried to file an appeal through The Illinois Department of insurance, but my husband's company is self-funded. They notified me that I would need to go through the external review process with the federal department of insurance. I did that last month, and I was notified today that they are upholding the insurance company's decision to deny my surgery. I don't know what to do. I know there are many of you on here that are going through the same thing or even worse. I'm hoping that maybe one of you may have a suggestion to an alternative therapy or surgery that could possibly be covered. I'm just looking for something, some type of hope. I'm 38 years old, I cannot live the rest my life like this.

Thank you

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Hello, Suzyhomebaker--we are so sorry to read your post. We hear a lot from people who have procedures that are not covered by insurance--it's incredibly frustrating.

Health insurance is incredibly complex. Can you share why your fusion isn't being covered?

While we're sure you've done this a million times, our best advice is to call the customer service number on the back of your insurance card to understand the other options you have available. Some plans cover physical therapy or injections--which may be good alternatives to surgery for you.

Without knowing the details of your specific health plan, we can't comment on types of treatments that might be covered. However, your insurance provider's customer service should be able to share those details and offer you some assistance.

We are so sorry you're going through this. We hope this helps and wish you the very best of luck!

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I'll be brief as possible. I am a 57 year old male. I have been a athlete my entire life. At the age of 19(1979) they wanted to fuse me. I exercised my way to health for another 30 years. Finally at 50 I had no choice.
Fusion RUINED MY LIFE. I remain in agony. Lost a incredible career. Had to sell every possession I cared about. Including a lovely home. I can't work,walk or sit. They call the operation a success.
I then became addicted to opiates because that's what happens to people with chronic pain and opiates.
I TRULY BELIEVE THIS IS A BLESSING. THERE ARE SO MANY ALTERNATIVES THAT DO NOT CRIPPLE YOU.
I became a CPT in corrective exercise,use acupuncture,and take Kratom for pain.
I get about 5-7 hrs a day out of bed. A horrifying life. Careful what you wish for

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Consider yourself LUCKY!
Don't do fusion.

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