Brand new here looking for advice, please?

[wendriful]

Yes, I have contacted him a few times and he was VERY helpful. The problem really comes down to this: I know who the best surgeon is; it's just that A. I am not sold on the disc he uses. and B. He hasn't responded with the total amount I need upfront and C. Even when he does respond, I definitely don't have the other family member involved in this financial decision onboard with that choice because of the obvious reasons: upfront payment needed without guaranteed reimbursement AND because I'm having difficulty raising that much cash period. I think I have a pretty good chance of getting it reimbursed because it sounds like my surgery has been 'downgraded' to a hybrid/one level ADR w/fusion, but I haven't received ANY correspondence from the aforementioned surgeon's office regarding insurance codes, letters for preapproval/necessity to insurance company, etc. And, they have not responded to the fracture that they missed either, aka: contraindication to 2 level ADR. I AM so afraid of falling into the 25% rate of people that are worse off than before surgery that I am hearing about, but the pain is at a point now that I just don't care anymore, I just want to lie in the O.R. and have them cut the pain out! (Clearly, that's not good). If I choose Plan B, I don't know how to find enough patient's stories in U.S. who have used the NY surgeon, is that because of HIPPA laws? Am I the only person who's financial health issues have made their spouse nauseated? (I am being facetious to a point, but do feel like a very large dollar sign these days). Maybe I should have a lemonade stand? ha ha

[Maria]

Wendriful,
I think this has been the reason many of us have foregone surgery maybe where we wanted to have it and utilized insurance paying for authorized procedures that were covered even if not our first choice. In my case I didn't do either in terms of 3rd surgery recommended. Guess I would have if I had to or would have to.

The 3rd surgery I was designated to have w/surgeon here in LA county had an office that was so difficult to reach and even was the cause of my 3rd surgery being un authorized because the surgeon/staff didn't fill out necessary paperwork in a timely manner as required by WC. I then had to try for 2 more years to get the surgery re authorized and when I did it was for a hybrid surgery vs. 2 level ADR. I definately didn't want the same surgeon who didn't get the paperwork done to perform the surgery even though I'm sure he was more than capable and I also didn't like how the office didn't respond to phone calls so in the end it did add to putting me off from going ahead w/surgery utilizing the surgeon/his practice as I thought if that was how I was treated prior to surgery how would I be treated afterwards?

That being said there are many persons that have come and gone on this forum who have had EXCELLENT results utilizing that surgeon/surgical practice and waded thru the office BS. I know I should not have let that influence my decision as one is looking at the skill/experience of the surgeon mostly.

Good luck w/your endeavor and however you have to proceed. Finances definately play a big part for most people. It is a big chunk of change to put out and while it's best to try to get it right w/best shot sometimes we have to make do with what is most feasible for us overall (thus possibly complicating the decision).

[dshobbies]

I'm sorry, I didn't mean to push so hard. You do not walk alone. It once took 6 months to receive a return phone call from a doctor and by then, I was so frustrated, I moved on.

Most of us who own homes in high priced areas like L.A., S.F., N.Y., etc. were able to tap into our homes equity - but those in areas like my nephew - my surgery was the same price as his whole house. Even then, we have to pay it back but can do so over a long period of time. There are also medical loans which carry high interest rates. From what I've read, those with limited financial circumstances don't have options other than fusion and even then, it's still up to the discretion of the insurance co.

It's sad but that's the way it is. I still wish you the best and hope it comes sooner rather than later.

Dale

[jsewell]

Wendriful

i so understand the spouse getting nauseated with the thought of the money involved. I never can even consider going out of the country. I have found that i have an awesome surgeon here near my home in Ca. He did send me out to DrRegan when he thought DrRegan was the better man for performing the surgery. DrRegan did take care of the pain in part of my thoracic spine but i have to now live with a devistating accident during surgery which has left me with only 45% lung capacity.
My spouse can't even handle the copayments on a PPO plan with a surgeon, that just accepts what the plan pays even though he is not a provider on the plan. He has my best interests at heart and has treated me well.

I do understand what you are feeling as when my insurance co, denied 3 times my most recent surgery to correct severe kyphosis and a broken neck!! THe thought of having to pay myself was very scary as we are in LA and do not even own a house! I had to go to my parents and them turning in some of their retirement income . Not a good choice.

Good Luck with this difficult decision. Unfortunately money does play an important part in it all.
judy

[wendriful]

Did I just read that correctly? Dr. Regan did a surgery on you and you woke up and couldn't breathe? (45% lung capacity) Are you on oxygen? Wow, my head is swimming over your prognosis. I am sorry to even mention my 'very' small issue after reading your post.

Well, it looks like I will be staying in the U.S. for surgery. I can get a line of credit out of our house but just think it would not be wise to pay upfront. If there is a complication and insurance does not pay (I have a friend this happened to for another surgery and she was in Mayo for 14 months, do the math on that). And I just had BCBS rescind payment for a different issue all together for my son which means I am paying the other $9,000 owed to them this week. go me. ha ha.

Thanks so much for ALL of your support. SO nice to be amongst people who get the whole "I have fallen but I can't get up" crowd. lol. Hey, humor has taken me many places in life. I believe I will be getting my hybrid (1 level fusion @ S1/L5 plus ADR at L4/L5 in New York City. If ya'll don't mind, I will hang out on this forum to get me through this process; and then, maybe I can be of help to others.

Funny, I thought my DH (darling husband) was gonna pass out when Mark called from Germany yesterday on my cell phone. He said that is $10 minute! I said he used skype...not sure if that matters, but he told me it was only 4 cents a minute...Thanks for all of you who get the whole: "I feel like a very large Greenback" concept. My best to all of you and no hard feelings to anyone; I don't feel like anyone came down hard on me at all.

[jsewell]

Wendriful
No issue is small, if you have not experienced something bigger , it is all big!! Yes i actually was put on a respirator for a while and in intensive care.
the really bad part was that DrRegan ignored the whole situation, never came to see me or even called my husband after the long surgery. He called my cell at the time i was on a respirator (wrong cell) and said everything was ok. My husband got any info from a volunteer in the waiting room. Once they got me stable (after many hours) he was only allowed to see me for 10 minutes.

The low lung function sucks as i am an avid exercisor.
Good Luck to you wherever you go for your surgery.
judy

[dshobbies]

Wendriful,

Agree with Judy, no issue is too small. I'm amazed at the small issues accumulating in my mind and find solace that others experience the same thing.

On BCBS rescinding payment - I know of another. He got a lawyer. Decisions were based on payment - BCBS backed down. They're counting on you doing nothing. He won very quickly. Can't afford an attorney - can you afford the 9k?

Dale