I filed a 2nd appeal and it was initiated and completed yesterday. I was told they would let me know their ruling as soon as possible. Hopefully I will hear something today.
The 2nd appeal consisted of me answering some questions from a panel of doctors and them reviewing my medical records. It also consisted of me providing additional information that was not in the original packet of records.
In the meantime, I am struggling with the pain. It starts off quite severe in the mornings and I am unable to take my pain medication because I haven't eaten. Once I eat, I try to take 1/2 a pill to get me through the day. It ends up making me quite nauseous and doesn't help the pain most days.
At night, I eat dinner and take a whole pill. By the time it takes affect, I am unable to do much other than go to bed. The nausea if awful and is impossible to function because of it. So, between the pain and nausea, I am not sure which I choose.
Wednesday, September 30, 2009
Tuesday, September 29, 2009
Frustrated...
Frustrated is how I feel, so I am blogging my thoughts. They are random and probably do not make much sense, but I just need to get it out.
In 2005 I was diagnosed with low back problems. I visited a chiropractor for over a year trying to alleviate some of the pain. In 2006 my family doctor referred me to an orthopedic specialist, Dr. Lilo. Dr. Lilo proceeded to take MRI readings of my back and X-rays. It was determined at that time there was a disk bulge and disk protrusion in my lower back. To help ease the pain, I was given a lumbar epidural (steroid injection). This worked quite well. My pain was eased for the next two years.
In the middle part of 2008, I once again found myself at Dr. Lilo’s office with recurrent back pain. The pain had gotten to a point that it was beginning to interfere with my life. I was unable to assist around the house and lift things that I normally could. I found myself in significant pain when leaning over to fold laundry or help my son’s with their homework. Dr. Lilo repeated the MRI and it was determined that my lower disks were still showing significant damage. Dr. Lilo repeated the lumbar epidural injection in February 2009 (it had to be delayed due to gallbladder surgery in December 2008). After one month, the pain was still quite intolerable. Dr. Lilo repeated the injection for the third time. After one month, the injection failed to eliminate the pain. Dr. Lilo then proceeded to inject with a joint facet injection. Directly inserting the steroid into the joints to help alleviate the pain. This injection also failed. The next step Dr. Lilo insisted on was physical therapy along with wearing a back brace. I went to physical therapy three times a week for over a month, with absolutely no relief. The physical therapists indicated that they were unsure how to help with my pain. After this, Dr. Lilo tried a sacral iliac injection (putting steroid directly into the sacrum area where the joints come together.) This injection also failed.
Finally, Dr. Lilo suggested I see a spine specialist because he was unable to treat me further at this point. I saw Dr. Rick Sasso the middle part of August and after reviewing my information he suggest a test called a discogram. This test would pinpoint specifically where the pain was coming from if it was coming from the disks. The test was completed on August 25 under Dr. Lilo’s care and it came back positive with degenerative disks at the L4/L5 & L5/S1 disks. Dr. Lilo’s referred me back to Dr. Sasso.
I met with Dr. Sasso and he gave me two options. Leave it alone if I felt it did not debilitate my daily living or surgery. By this time I have went from using pain medication for relief maybe twice a week to every day. My opinion is that is does impair my daily living, so Dr. Sasso and I agreed the only other option was surgery. The surgery consisted of a lumbar spinal fusion.
My surgery was schedule for Tuesday, September 29. On Thursday, September 24 I received a letter from my insurance company (Anthem) indicating this surgery was not medically necessary. This is the same insurance company that has covered each and every one of my prior visits, including the discogram. I filed an expedited appeal on Friday, September 25. I called Dr. Lilo’s office and they faxed to my insurance company the documentation from the past four years.
Monday, September 28, 2009 I received a call from the insurance company that the appeal has been denied.
I live in severe pain each and every day. I cannot function to the ability that I normally function. I must get up every 20 minutes or so and walk while I am working. If I am standing for more than 20 minutes I must sit down. I cannot exercise as it puts too much stress and pain on my back. I cannot lift items, I cannot do my laundry because it requires me leaning over to put items in or picking up laundry baskets. I cannot sit in my classes to finish my education. I cannot sit to do my homework, the pain is too unbearable. If I take my pain medication I get sick to my stomach. It makes me drowsy, therefore I cannot take it while I work, drive, or go to school. I have had to leave classes early due to the pain or the medication. I have missed work because of the amount of pain I am in.
I work 40 hours a week and take 14 credit hours in college. I am a mother to four boys (ages 14 – 10) that are active in sports. I cannot even sit in the bleachers to watch their games because the pain is too severe.
I do not want to live on addicting pain medicine for the rest of my life!!! I have taken all the necessary steps to take care of this problem and treat it, but my insurance company is telling me fixing it is not necessary.
So am I supposed to go on disability? Am I supposed to quit my job because I can’t function? Am I supposed to quit school because I can sit in the sits and I can’t take pain medicine to make it through the night?
What is someone supposed to do in this situation? I pay a lot of money for health care that is supposed to help me. It isn’t helping me, it is forcing me to become sedentary and lose what abilities I have. Is this the kind of nation that we want? I do not live on assistance from anyone. My husband lost his job more than 3 years ago and we NEVER once asked for assistance. We work hard and thought we lived in a nation that takes care of its people. How can insurance companies dictate my standard of living?
I want to be healthy and free of pain. I am aware the surgery may not get rid of it 100% but I want to be able to function again. I want to wake up and not groan because I would rather be sleeping where I am pain free (when I can sleep.)
What is an American citizen supposed to do?
I have filed a 2nd appeal but I have since had to cancel my surgery. I had made childcare arrangements for my children while I would be in the hospital. My husband (who has found part-time work) made arrangements with his employer to be with me. I made arrangements with my employer to be off 6 – 12 weeks (without pay) and now I cannot have the surgery. I even had to pay $25 (out of my own pocket) for special insurance forms for my employer. That is what the doctor’s office charged to fill out FLMA paperwork and now I am out that money!
I am angry, hurt, frustrated, and in severe pain!!! What is a person supposed to do? I even had to leave class early last night because the pain was so severe and the medication made me so sick that I couldn't function.
I need this surgery to return to a somewhat normal life. I need relief from the pain...even the possibility of that is far better than what I deal with on a daily basis.
I am continuing to pray for a miracle. I am continuing to pray that the insurance company sees that it is creating a much worse environment by allowing its members to suffer.
I am continuing to put all my love and trust into God. It's all I can do.
In 2005 I was diagnosed with low back problems. I visited a chiropractor for over a year trying to alleviate some of the pain. In 2006 my family doctor referred me to an orthopedic specialist, Dr. Lilo. Dr. Lilo proceeded to take MRI readings of my back and X-rays. It was determined at that time there was a disk bulge and disk protrusion in my lower back. To help ease the pain, I was given a lumbar epidural (steroid injection). This worked quite well. My pain was eased for the next two years.
In the middle part of 2008, I once again found myself at Dr. Lilo’s office with recurrent back pain. The pain had gotten to a point that it was beginning to interfere with my life. I was unable to assist around the house and lift things that I normally could. I found myself in significant pain when leaning over to fold laundry or help my son’s with their homework. Dr. Lilo repeated the MRI and it was determined that my lower disks were still showing significant damage. Dr. Lilo repeated the lumbar epidural injection in February 2009 (it had to be delayed due to gallbladder surgery in December 2008). After one month, the pain was still quite intolerable. Dr. Lilo repeated the injection for the third time. After one month, the injection failed to eliminate the pain. Dr. Lilo then proceeded to inject with a joint facet injection. Directly inserting the steroid into the joints to help alleviate the pain. This injection also failed. The next step Dr. Lilo insisted on was physical therapy along with wearing a back brace. I went to physical therapy three times a week for over a month, with absolutely no relief. The physical therapists indicated that they were unsure how to help with my pain. After this, Dr. Lilo tried a sacral iliac injection (putting steroid directly into the sacrum area where the joints come together.) This injection also failed.
Finally, Dr. Lilo suggested I see a spine specialist because he was unable to treat me further at this point. I saw Dr. Rick Sasso the middle part of August and after reviewing my information he suggest a test called a discogram. This test would pinpoint specifically where the pain was coming from if it was coming from the disks. The test was completed on August 25 under Dr. Lilo’s care and it came back positive with degenerative disks at the L4/L5 & L5/S1 disks. Dr. Lilo’s referred me back to Dr. Sasso.
I met with Dr. Sasso and he gave me two options. Leave it alone if I felt it did not debilitate my daily living or surgery. By this time I have went from using pain medication for relief maybe twice a week to every day. My opinion is that is does impair my daily living, so Dr. Sasso and I agreed the only other option was surgery. The surgery consisted of a lumbar spinal fusion.
My surgery was schedule for Tuesday, September 29. On Thursday, September 24 I received a letter from my insurance company (Anthem) indicating this surgery was not medically necessary. This is the same insurance company that has covered each and every one of my prior visits, including the discogram. I filed an expedited appeal on Friday, September 25. I called Dr. Lilo’s office and they faxed to my insurance company the documentation from the past four years.
Monday, September 28, 2009 I received a call from the insurance company that the appeal has been denied.
I live in severe pain each and every day. I cannot function to the ability that I normally function. I must get up every 20 minutes or so and walk while I am working. If I am standing for more than 20 minutes I must sit down. I cannot exercise as it puts too much stress and pain on my back. I cannot lift items, I cannot do my laundry because it requires me leaning over to put items in or picking up laundry baskets. I cannot sit in my classes to finish my education. I cannot sit to do my homework, the pain is too unbearable. If I take my pain medication I get sick to my stomach. It makes me drowsy, therefore I cannot take it while I work, drive, or go to school. I have had to leave classes early due to the pain or the medication. I have missed work because of the amount of pain I am in.
I work 40 hours a week and take 14 credit hours in college. I am a mother to four boys (ages 14 – 10) that are active in sports. I cannot even sit in the bleachers to watch their games because the pain is too severe.
I do not want to live on addicting pain medicine for the rest of my life!!! I have taken all the necessary steps to take care of this problem and treat it, but my insurance company is telling me fixing it is not necessary.
So am I supposed to go on disability? Am I supposed to quit my job because I can’t function? Am I supposed to quit school because I can sit in the sits and I can’t take pain medicine to make it through the night?
What is someone supposed to do in this situation? I pay a lot of money for health care that is supposed to help me. It isn’t helping me, it is forcing me to become sedentary and lose what abilities I have. Is this the kind of nation that we want? I do not live on assistance from anyone. My husband lost his job more than 3 years ago and we NEVER once asked for assistance. We work hard and thought we lived in a nation that takes care of its people. How can insurance companies dictate my standard of living?
I want to be healthy and free of pain. I am aware the surgery may not get rid of it 100% but I want to be able to function again. I want to wake up and not groan because I would rather be sleeping where I am pain free (when I can sleep.)
What is an American citizen supposed to do?
I have filed a 2nd appeal but I have since had to cancel my surgery. I had made childcare arrangements for my children while I would be in the hospital. My husband (who has found part-time work) made arrangements with his employer to be with me. I made arrangements with my employer to be off 6 – 12 weeks (without pay) and now I cannot have the surgery. I even had to pay $25 (out of my own pocket) for special insurance forms for my employer. That is what the doctor’s office charged to fill out FLMA paperwork and now I am out that money!
I am angry, hurt, frustrated, and in severe pain!!! What is a person supposed to do? I even had to leave class early last night because the pain was so severe and the medication made me so sick that I couldn't function.
I need this surgery to return to a somewhat normal life. I need relief from the pain...even the possibility of that is far better than what I deal with on a daily basis.
I am continuing to pray for a miracle. I am continuing to pray that the insurance company sees that it is creating a much worse environment by allowing its members to suffer.
I am continuing to put all my love and trust into God. It's all I can do.
Monday, September 28, 2009
Latest on my surgery
As of right now, my appeal has been denied. I am working on whatever options I may have available.
Continue to pray.
Continue to pray.
Friday, September 25, 2009
Requesting a miracle-updated
Friday Afternoon Update
I did not receive a call about the appeal, so I have to wait until Monday morning. Continue to pray, please.
Another update
I received a call from the insurance company indicating the appeal is in process. I may know something this afternoon. If not, I won't know until Monday morning.
********UPDATED*********
I received a call back from my original doctor, they have faxed (upon my request) all my clinical paperwork since I have been at their office for this problem. The faxed CT scans, MRI's, epidural injection information, and anything that pertained to my back.
I received another call from my insurance company indicating that if they received it before 2:00 p.m. I should have an answer before 2:00 p.m. on Sunday, but they would try to get it taken care of today.
PRAY for approval!
Original Post
I received a letter yesterday from my insurance company denying benefits for my surgery. I have spoken with the doctor's office and they indicated I needed to be my own advocate (WTF) and fight the insurance company. I have left a message with the insurance company appeals department (expedited appeal section) and I have called and left another message for my original doctor (that I have been seeing for 4 years about this problem).I am frustrated and in severe pain. The claims department said they would expedite an appeal if the person is in "severe pain that is unmanageable". I am at that point. I cannot sleep, stand, sit, or walk without pain. The pain meds make me very nauseous and tired so I can't take them at work (besides the fact they don't even begin to touch the pain itself - kind of like putting a bandaid on an amputation.)
I paid $25 (of my own money) to have the FMLA paperwork filled out (that is what my doctor's office charged me for special insurance forms.) If I don't have the surgery on Tuesday, then I am going to have to pay the $25 again to have new paperwork filled out when I can get the surgery approved. My doctor's office said if I could come up with half of his charge ahead of time they would proceed (his charge is $45,624 - so I would need $22,812). She then indicated to me that she could try to talk the doctor into taking half of the $22,812 as a first payment so we could proceed. That is fine and dandy but we DON'T have that kind of money. We are living paycheck to paycheck with my husband working part-time (finally).
Ok...now the ranting part. I pay VERY good money(read I pay LOTS of money) for my insurance. The cost of this insurance reduces my bi-weekly paycheck in half! Why the hell I am paying that kind of money for them to not take care of my needs?
I am pissed, hurt, angry, sad, and discouraged. I am depressed and in severe debilitating pain. do they think I really want to have a surgery that is going to put me out of work for over six weeks. Six weeks in which I will NOT receive a paycheck because I don't have sick time banked? Seriously!
Now, I am waiting on a return call from my original doctor. I need to get those records to my insurance company. I need it YESTERDAY, not in twenty minutes, not in two hours,...grr!
Do you know how it feels to sit, stand, or walk with such pain? To have it shooting through your back almost dropping you to your knees at times?
Why wouldn't this surgery be medically necessary? I virtually have no disks left in my lower spine.
Sorry, but I am pissed. My sentences make no sense and I don't care.
I need a miracle.
Monday, September 7, 2009
My boys-School Photos
I took some new pictures of my boys tonight. They are growing up so fast. It's hard to believe that I have boys this age. It seems like just a couple of years ago that I was in 8th grade, now my oldest son is.
Enjoy the pictures...
Caleb K. & Smiley
Enjoy the pictures...
Tyler J.
2009-2010
Caleb K.
2009-2010
Caleb K. & Tyler J.
2009-2010
Tyler & Smiley
2009-2010
Fun Shot
Caleb K. & Smiley2009-2010
Fun Shot
Saturday, September 5, 2009
Take the Time
Ever heard the phrase "If it weren't for bad luck, we'd have no luck at all?" I feel that has become our motto.
Over the past year a myriad of personal "tragedies" have overtaken our lives. Each one in it's own way devastating. Each time we survive only to find ourselves thrust into another "tragedy". A recap, if you will:
Two weeks ago tomorrow, Caleb broke his wrist. He is doing much better but the break ended his football season.
Two days ago, Tyler was rushed into emergency surgery to remove his appendix. It was on the verge of rupturing (fortunately it didn't) and needed to be removed quickly. The day started like any other, only his stomach was hurting. By noon he was being admitted to the hospital and by 2:30 he was in surgery. He is resting comfortably (as much as possible) and waiting to be discharged. It looks like he can go home tomorrow. The surgery has effectively ended his football season also.
Over the past year the events that have taken place in our lives seem to overwhelm us at times. It all began with a family member trying to take her own life, a month later my father-in-law passed, a month after that I was hospitalized for several days, our finances have been hit hard, I have had major back issues (which look like surgery will be needed), and then Caleb and Tyler with their latest injuries/illnesses.
I feel strongly that everything happens for a reason. I believe that God will bring me through it all and I will be a stronger person. I believe that as bad as it seems, things could be so much worse. But most of all I believe that I have the best family a person could ask for and without them I would not be able to survive. God is always by my side and without Him nothing is impossible. I feel the same way about my family.
Take time to hug your loved ones. Take time to tell your children how much they mean to you. Take time to call an old friend. Just take the time.
Have a great labor day weekend.
Chris
Over the past year a myriad of personal "tragedies" have overtaken our lives. Each one in it's own way devastating. Each time we survive only to find ourselves thrust into another "tragedy". A recap, if you will:
Two weeks ago tomorrow, Caleb broke his wrist. He is doing much better but the break ended his football season.
Two days ago, Tyler was rushed into emergency surgery to remove his appendix. It was on the verge of rupturing (fortunately it didn't) and needed to be removed quickly. The day started like any other, only his stomach was hurting. By noon he was being admitted to the hospital and by 2:30 he was in surgery. He is resting comfortably (as much as possible) and waiting to be discharged. It looks like he can go home tomorrow. The surgery has effectively ended his football season also.
Over the past year the events that have taken place in our lives seem to overwhelm us at times. It all began with a family member trying to take her own life, a month later my father-in-law passed, a month after that I was hospitalized for several days, our finances have been hit hard, I have had major back issues (which look like surgery will be needed), and then Caleb and Tyler with their latest injuries/illnesses.
I feel strongly that everything happens for a reason. I believe that God will bring me through it all and I will be a stronger person. I believe that as bad as it seems, things could be so much worse. But most of all I believe that I have the best family a person could ask for and without them I would not be able to survive. God is always by my side and without Him nothing is impossible. I feel the same way about my family.
Take time to hug your loved ones. Take time to tell your children how much they mean to you. Take time to call an old friend. Just take the time.
Have a great labor day weekend.
Chris
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