Denied
 

Well I don't have to worry about the SCS anymore. WC denied it entirely. Does anyone know of a good vet??

From what I have seen on this board the SCS is about 50/50, so I wouldn't get too discouraged...WC sucks and I am so sorry you were denied:hug:

Hi Lisa ...
 

Sorry to hear this......

Did your Pain Dr/Surgeon write a letter of medical necessity to the Insurer?
I was under the impression that if that letter is sent, that pretty much seals the deal......but i have no knowledge whatsoever on WC or all the factors involved.....

I hope things work out for you soon......for all we know maybe the SCS would have caused you more problems..... ? ....
Otherwise, if you feel in your heart it is something you truly want to pursue (at least the trial implant), is there a way to see if your primary insurer would cover?
I really do think it all boils down to that letter of medical intent from the Dr.

Caring
Rae
:hug:

Hi Lisa,
Are you disappointed or somewhat relieved?
I am wondering what their rationale was for denying you the treatment that you requested? Do they think it is 'not medically necessary'?
The criteria used baffles me (well, not really....the criteria is cost..)....such as in my case, how can aqua therapy which reduces swelling and keeps mobility in the rsd affected limbs not be 'medically necessary'????? :mad:.....denied!
Did your WC insurance offer an alternative treatment??
I am sorry you were denied, Lisa, if you were really counting on this modality....
Perhaps a blessing in disguise?

p.s. my veterinarian used to make housecalls...........:o

Hugs from Hope4thebest :hug:

Lisa...
I am very sorry for your denial...I understand your dissappointment is in that we open our selves up for any intervention possible..and being denied takes it out of our deserving hands... allowing us the decision is one hting but for them to say.. No!! That is a horse of a different color..I have a SCS..I ma wired but did not get good results and had spread so honey..I hope this helps you.... Plus your comment about the vet made me roll..You brought a fun smile to my face..Hang in there..possibly the SCS was mean't to happen for you...Take care and have faith..

hugz, Kathy:grouphug:

WC is such a different thing to deal with not like pvt ins at all.

Have you posted /visited out wc forum?
you may find some tips to help deal with the wc issues, appeals etc.
http://neurotalk.psychcentral.com/forum30.html

I am sorry if you are saddened by this. But from what I have read this truly may be a blessing in disguise. Look for another door to open or if this is something that you really want to try then as will the rest of the best you will have to fight!!!! I too had a huge belly laugh about the vet. Sorry for your disappointment. God Bless

Jeanie

Did you get the Utilization Reveiw form back from them ? What reason did it give for the denial ?

Peer review of the information presented and/or discussion with a contracted Physician Advisor and the medical provider, it has been determined that the above health care service does not meet established treatment standards of medical necessity. End quote. Really do not know what to do next. I do not seem to be getting much relief from my meds and things seem to be getting worse fast. Hope you are all having a good evening and wish a good night's sleep to all!! Lisa

I found this at http://www.painmed.org/pdf/medical_t...guidelines.pdf

Standard of Care/Medical Necessity

Indications for SCS


• Failed back syndrome (persistent pain in patients who have undergone at least one previous back
operation), more helpful for lower extremity than low back pain, although both stand to benefit,
40-60% success rate 5 years after surgery. It works best for neuropathic pain. Neurostimulation
is generally considered to be ineffective in treating nociceptive pain. The procedure should be
employed with more caution in the cervical region than in the thoracic or lumbar.
• Complex Regional Pain Syndrome (CRPS)/Reflex sympathetic dystrophy (RSD), 70-90%
success rate, at 14 to 41 months after surgery. (Note: This is a controversial diagnosis.)
• Post amputation pain (phantom limb pain), 68% success rate
• Post herpetic neuralgia, 90% success rate
• Spinal cord injury dysesthesias (pain in lower extremities associated with spinal cord injury)
• Pain associated with multiple sclerosis
• Peripheral vascular disease (insufficient blood flow to the lower extremity, causing pain and
placing it at risk for amputation), 80% success at avoiding the need for amputation when the
initial implant trial was successful