And the oral surgeon’s assistant literally did not believe me when I said it was approved. She was like “that NEVER happens; you’re the first person I’ve ever seen be able to get this approved.”
So… I guess people who aren’t able to spend 10 business hours on the phone lose out. 
Yes, that’s what I was quoted.
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Was it approved by the medical plan?
I’m trying to remember!
Yeah, I think it was medical insurance that covered it, and they made it clear that it was only because Mini Me was so young.
If an adult needs an anesthesiologist for a dental procedure we are just SOL. That said I think oral surgeons will do more anesthesia in the office for an adult than they will for a child. Still…
This is the kind of crap the insurance industry needs to fix if they want to stave off single payer.
Ok, got the denial letter from insurance RE the MRI. They want me to have 6 weeks of therapy before doing an MRI. Yet most articles say you don’t need to seek treatment for low back pain unless it lasts 6-8 weeks.
Also, the cost of the original physical therapy place, had I gone for 6 weeks, was MUCH higher than the cost of an MRI.
So just pay for the freaking MRI!
Well dang, I wrote all my notes for the fabulous letter, and then decided to call when I realized it had been more than 6 weeks since my initial dr visit, yada yada. Not to mention that the MRI was cheaper than the first PT place. So I decided to call and they said, yeah, it was already approved. Sheesh they stole my thunder. And also, WTH do ordinary people who don’t speak insurance-ese do when they get these letters? No wonder our collective mental health is so awful in this country.
But anyway, they should apply the cost of my MRI to the deductible.
And with how this is going, I’m having hubs call my ortho surgeon today to start talking about surgery to fix his foot. We’ll likely meet the deductible before he schedules the surgery.
Got my MRI results. Couple of “mild bulges” and a little arthritis & from the wording it sounds like none of it is horrible nor should it be causing this much pain. Sent the report to my chiropractor (he asked for it) so maybe he’ll have some advice for me. Or maybe I’ll actually hear from my PCP.
Assuming my PCP is less than helpful, what kind of specialist should I be talking to?
Here is part of the report, should anyone care to play doctor and take a stab at it.
I dunno, based on Foraminal Stenosis (webmd.com), it sounds like your condition could generate significant pain depending on where and extent of the nerve pressure being generated.
Your chiropractor might be a good start for getting immediate relief, but I’m think a neurologist might be the specialist to consult for this sort of thing.
Yep, chiro said if that 10.1 were <10 it would be immediate surgery.
PT said, oh, nothing major, we can fix this. 
Haven’t heard from PCP.
Will definitely be seeking a specialist.
Wait. On top of all the other us insurance stuff, now insurance companies are requiring courses of treatment?
That’s certifiably insane.
Only if you want them to pay for it. Trying cheapest option first when medically appropriate sounds reasonable, but sometimes isn’t easily adjusted to circumstances.
I understand the rationale. But I’d prefer those decisions to be made by my doctor.
Yes. It could be physical therapy or steroids or injections (which I guess are also steroids). My dr was specifically being conservative bc of my blood pressure.
They’re made by a peer doctor employed by the insurance company. Who often has no understanding of the situation. Like a cardiologist deciding if a spine surgery is medically necessary right now.
It’s called peer to peer review and it’s good in theory and horrible in practice.
So in 2022 a pulmonologist sent me for an echo. In retrospect, I know he was being overconservative and that the test result he used to justify the echo could have been caused by low iron and he never asked if I had a history of anemia. (Several months later I would figured out on my own that my anemia had reared its ugly head, after several doctors missed it, in spite of my regular complaints of fatigue.)
I get the echo at a local hospital. Insurance declines it and says I don’t owe anything bc of the no surprises act. I had already paid like $700 which was my part. I’m thinking I’m never gonna get that money back so I let it slide. Then at tax time I’m looking at my expenses for the year and—hey—insurance covered that after all! They never informed me.
Meanwhile, the pulmonologist barely even mentioned the echo at my follow up. I had read the report but forgot about my questions by the time I had my follow up. A friend who does echos for a living helped me with the interpretation, so I wasn’t worried and sort of forgot about it.
Anyway, in that case there was really no reason for the echo and they ultimately approved it. I would have been fine with not having it once I understood the reason.
Different sitch with this 9/10 pain & having to jump thru hoops for an MRI. As it is it’s a month to get into a specialist and who knows how long if I need surgery. I’m glad I got the ball rolling.
Agree, but if you already tried that when you had a different insurer then it is not reasonable to make you retry it.
My PCP never received the results of my MRI. She looked at results on my phone this morning and decided the only specialist I need to see is pain management. I didn’t argue with her, just said I’ll wait a few more weeks. I already have an appointment with a specialist early April. They do both surgical and non surgical treatment and the wording on their website says most back issues don’t require surgery. I just feel more comfortable working with a specialist who is actually going to examine me.
Still dealing with sciatica but I have a different question.
This morning while trying to find a comfortable position to get a bit more sleep, I rolled to my right side and felt a sharp pain under my ribs on that side. Bad enough to sort of cry out and it made my husband worry. I feel like it’s about where my gall bladder used to be (it’s been gone about 20 years) and I’ve long wondered if I had scar tissue there bc I get a weird pain from time to time, but it’s short lived and not as severe as this was. Is that a thing?
I googled and found a lot about scar tissue in the months after surgery—but 20 years later?
But none of the other things I found re: right side pain sounded reasonable, and it’s not bad enough to go to the ER or anything. It’s way too high to be the appendix, and I am not sick.
