trouble getting approval for surgery
 

I am a 28yr old with some crazy back problems all job related. Started with PT for four weeks, when I got no relief they sent me for an MRI. MRI showed herniated disc at L5-S1 so then insurance company sent me to orthopedic specialist.
He started with epidural shots and PT. After 6 months with no releif he did surgery ( a laminectomy). Then sent me back to PT but I was still having pain that continued to get worse. I could tell he was about to 'write me off" so i went to another dr.
A neuro spine specialist... He has tried epidual shots and water therapy and pain continued to increase. Says I had 'failed back syndrome" and says we need to do surgery again. Now this Dr I actually trust and thouroughly explains procedures to me and answers all questions. He feels our best bet is a 360* spinal fusion of L5 and S1.
I have since obtained an attorney and he is dealing with the insurance company. I have read 'the good and the bad' of this surgery and feel comfortable that my dr thinks it will work.

Why is the insurance fighting this. Their main argument is MY AGE, they want me to go see ANOTHER dr... has anyone else had this problem? I am done with other Drs... I like and trust the one I am seeing now. Can anyone give advice?
Should I have the surgery? NOTHING ELSE has helped. Right now I am taking many meds :Lyrica, Cymbalta (nerve pain and dr feels i am getting slightly depressed due to being in pain for a year), Skelaxin, Ambien CR, and 5mg percocet (which are begining to not help with the pain anymore).
I just want some relief!!! so i can play with my kids without tiring out so fast or not being ablle to get up and do anything. Running the Vaccuum is TOO MUCH for my back.
Please can anyone give me ANY advice on what to do or how to deal with the insurance company?:confused::(

Hang in There!
 

I,too, have a WC case. I have been "dealing" with the WC ins. co. for the past 2 yrs. I have an atty., and once an atty. is brought in, it is the atty.'s job to deal with the WC ins. co. However, I am constantly in contact with my atty.wanting to know why, what, when...now what???

My hubby is the one blowing his fuses wondering is our atty. DOING ANYTHING! I constantly have to remind hubby that WC cases are famous for being SLOW..tedious..and my experience with WC is the understanding that "hurry up and wait" is the norm.

I don't agree with the slowness of this dance with WC;however, it is my job to focus on my health and try to stay calm and stress-free, as my CRPS I is heightened if my stress levels are activated. I think the most difficult aspect of my 2 yr. journey with RSD and WC is to realize that I am not in control of this process. I can be active in MY PERCEPTION of my physical, mental, and spiritual well-being.

I see a psychologist every 2 weeks to stay focused on the part of the WC case that I can have a say in..ME! I choose not to play their game; that is why the atty. was brought into the matter.

Chronic pain pain, loss of mobility, and the lack of money, are hard to deal with and usually brings depression and anxiety issues into the fight with WC.
I found that all the meds I have to consume on a daily basis is a daily reminder that my LIFE is in a topsy-turvy state.

Please take time just for yourself, and remember, YOU can change the way you perceive the WC and RSD culprit; specifically, the WC case will not be settled immediately.

I wish you well. I am here for you.:grouphug:
Dew

mystic fairy, the reason that they will drag their feet is that fusion is something that they prefer to reserve for older patients. But in your case they need to take the "after all else fails" position. See if your neurosurgeon can get a consultation to support his position recommending surgery. As an ex-claims examiner, we always had concerns for what we commonly thought of as last ditch types of surgery on younger claimants. However, that has to be tempered by an understanding of the inability to move forward with one's life or career with an unsolved injury and the resultant pain.

I am sorry to see you taking so much pain medication. Fusions are supposed to help relieve some of that by immobilizing the structures around the nerves. I will be pulling for you.