Insurance company does not want to authorize my surgery

Discussion in 'Fibromyalgia Main Forum' started by janie056, Jan 4, 2007.

  1. janie056

    janie056 New Member

    I just received a call from my surgeons office and CIGNA does not want to authorize my surgery. I am having a spinal fusion on two levels. I had surgery in april and have had therapy after but the pain just kept getting worse!
    So the new MRI showed that I have two levels with NO DISK! I have bone on bone and can hardly move .
    CIGna wants me to have SIX MONTHS OF THERAPY! If I did I would be crippled!!
    I am so upset I am shaking and crying and feel a huge flare coming on.
    I have been siking myself up for weeks for this surgery, getting prepared, having blood taken yesterday,, have had a cortisone shot in my elbow today, because I will be using my arms after surgery to lift myself and I have tennis elbow and it just started to act up again, I have my pre-op next week and am getting everything in line for this.
    HOW CAN THEY DO THIS.
    The nurse sent over my new MRI and file to them today for the reveiw!!!
    I can't type anymore feel sick to my stomach!!!
    Please pray that this stupid insurance comapny who knows better than the top neurosurgeon on the east coast knows that they will authorize this and my surgery date will not be affected. I CAN'T WAIT ANY LONGER!!

    tHANK YOU,
    jANE
  2. NyroFan

    NyroFan New Member

    Jane

    Re-read your policy if you have it. Very often it says you can get a second opinion with another doctor and they will pay for that usually.

    I hope that helps.

    nyrofan
  3. Dixie_Amazon

    Dixie_Amazon Member

    See if your Doctor will call CIGNA directly for a peer review.
  4. janie056

    janie056 New Member

    In april I went to an orthopedic doc who told me right there and then I needed a fusion. I was so scared I went to the neurosurgon my family had used for my nephew when he was a baby, he had a brain tumor and saved his life!
    The Neurosurgeon said he would try and save me from having a fusion, but when he went in he saw more than what he did on the MRI and just cleaned up some disk, and took out bone and scar tissue. He then told me there were no guarantees that this would do the trick but let's hope so.
    It did not, and now I have no choice.
    I do have Medicare just for hospitalization, I don't know if this will help, since cigna will not have to pay the entire price of the surgery, maybe?
    If they deny me this surgery you bet I will call an attorney as fast as I can dial my phone!
    Damn them anyway, sorry!
    I'm just so upset.

    Jane
  5. janie056

    janie056 New Member

    bumping, just want to know if anyone else has gone through an insurance problem like this?

    Jane
  6. momof471

    momof471 New Member

    I have Cigna and they are absolutly horrible! I don't have any advice for you, but I pray you will get to have your surgery.
  7. firefighter01

    firefighter01 New Member

    The hospital should cut you some kind of break if the insurance won't pay for it b/c they get all the money back at the end of the year from the gov't. I think you have to file some kind of papers and I also don't know if it is just ohio that does that and so on. :) good luck will be prayin for ya!!
  8. kirschbaum26

    kirschbaum26 New Member

    Dear Jane:

    So sorry that this is happening to you. I would check your policy and see if they have a second opinion clause. Obviously, you do not want to have surgery that is not needed, but if you are in that much pain, and it clearly has a source that can be corrected, I would guess that any orthopedic surgeon or neurosurgeon you went to would agree with your doctor.

    Fight for your rights, and do not take no for an answer. Request to speak with a supervisor...if they cannot help, ask for someone higher up the ladder. Get your doctor's office involved and let them fight. Oh, if you do get the needed pre-authorization, be sure to have it in writing and keep a copy of it. I have learned the hard way that insurance companies can try to play games with you after the fact.

    Good luck.

    Ingrid
  9. monamea

    monamea New Member

    Hi janie456

    I too have been denied surgery by my insurance company. I have 5 Drs. who want me to have a gastric bypass. They said that it is needed for me in order to keep going, I have lymphedema, sleep apnew, narcolypse, and now I am a diabetic. The man who makes the decision at the insurance company has denied me. This is the 4 year in a row, everytime they submit it the insurance co. adds something else that has to be done before I can have the surgery. My Drs. and I are so fustrated. My fibro and other problems are getting worse but the insurance co. thinks that they know me better turn me down. Don't you wish you could go to them and shake the living h___ out of them!! I'm not sure either what to do to make it happen! Does anyone know how to get the insurance co. to believe in my Drs. and in me and my knowledge of my body???