[Maria]

I'm wondering whether this is a Worker's Compensation Insurance Denial or Medical Insurance Denial. I think either are difficult to deal with however, I had received a number of WC Utilization Review denials for surgery and it took approximately 2 years to get an authorization for a hybrid surgery (fusion at L5S1 and ADR at L4).

Originally I had been told in 2003 I could have a 2 level ADR during Prodisc trials but I was afraid at that point to have surgery. In 2005 I was told the WC legislation in CA. had changed and this surgery would no longer be authorized by UR and it wasn't so then the battle for 2 years to get a surgery that had already been previously authorized done so again.

The State of CA.Work Comp Board sent me to 2nd surgical opinion (even tho I already had 5 opinions in favor of surgery) to determine whether this surgery was warranted. Mark accompanied me as a Patient Advocate and I believe his presence/assistance was greatly helpful, esp. since the surgeon and he went over films in detail rather than just having some things pointed out to me very briefly or not at all while surgeon may have reviewed films in office w/o my presence even (as is often done w/WC).

Appeals can be lengthy and one must be tenacious/dig heels in~ there are those here that have made headway with regular medical insurance and WC. When all else fails or if the process is taking way too long and/or you just
want to try to get on w/your life, if at all possible, the option of going abroad is there and significantly cheaper than cost of the surgery here in the States.