Another fusion denial
A client of mine had a 3-level lumbar fusion denied in July, just 2 days prior to surgery. It was somewhat surprising, because his DDD is so severe, most surgeons would feel very justified in doing such a surgery.
The surgeons are telling us that the insurance companies are emboldened to deny more and more surgeries, based on the "same outcomes 2 years out" studies. It's really a shame, because in many cases, fusion really represents the patients' best option.
However, in this case, we are saying that he is VERY LUCKY to have the denial. Further investigation determined that his major pain generator was a sacral tarlov cyst. Clearly, the fusion would not have addressed the problem that they were trying to solve or improve. (I don't know if I've ever had the occasion to uttered a prase like, "boy are you lucky the insurance company denied your surgery!")
As the insurance companies continue to raise rates, cut remibursement levels, cut services and increase profits; things will get worse. Whatever your politics on healthcare reform, it's hard to imagine things getting better with or without the pending reforms.
Mark
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