I'm so sorry. This is beyond frustrating. It's criminal. They have no idea what we, as patients have to go thru daily, and they don't care. Their main concern is to save the company money. But sadly this happens all the time. Your only recourse is to do what they said - to get letters from everyone saying how it affects your daily life, yadayadayada.

And while you're collecting all this nonsensical data, your pain goes thru the roof because they've added more stress. It sure makes a lot of sense, doesn't it. It makes me mad just to think of it.

I'm so sorry this has happened to you. God bless. Hugs, Lee

I have Aetna too and they suck. They deny all sorts of things for me. Right now they are not paying for my therapy even tho I have 4 prescriptions from 4 differnet drs. I understand what you are going thru, it's frustrating,

Ugh! I have no respect for big health insurance companies like that. You are right... why pay health insurance every month if you can't get surgury? Could you switch health care plans? I find I don't get denied anything for BlueCross. Good luck!

ah this is why I laughed and cheered so hard at Saw 5 where all the people beeing tourcherd and killed all worked for an evil health insurence company, ah was nice to see people like that get it...sorry for the image that is just how much I hate health insurence companies. There have been so many times I was screwed by health insurence company. I remember one time with my back I had done a ton of pt and months later with no warning, they called my pt officed and demanded a refund and I got billed over 1,000 because they thought it was workmens comp when it wasn't. Oh I called and screamed at them for that, people next door could hear me yelling at them...I don't have anger managment issues I really dont heheheh. There was another time I was behind on a payment so I shiped it fedex to them and they missed it cancled my insurence then when I called and yelled they did a search and couldn't find it so my health insurence was gone, then when I got a new one I got a letter saying they found my payments and said they can put me back on for 900 more I said them to kiss my ass. I really wished we lived in Europe I would happly pay more taxes to have the goverment pay for all my heath care. I don't have any easy answers for you, you can call and scream at them probably won't do any good but it would make ya feel better. Beyond that all I can offer is a sorry and hope things get better for you

Don't feel too bad, aetna can be quite vicious. I had a cardiac cath, which they refused to pay to the tune of $38,000. they had previously refused the nuclear stress test, so my dr. told me to go to the ER and complain of chest pains, and he would do the cath after I got admitted.
Needless to say, he is quite fed up with the insurance companies. At least now I can rest assured that there were no clots.

I was denied injections for my pain almost 2 years ago by my insurance because it was workman's comp. Sounds like business as usual. Glad i have a lawyer to help me get some pain care.

Insurance companies are the worst blood sucking companies on the face of the earth! Do what you got to do to get your surgery, call and call and call until they get tired of you! Talk to supervisors, talk to anyone that will listen, become a pain on their butt until they will approve your surgery, that is what I did, and they finally approved me! Don't give up!

i also was denied surgery i have DDD in three levels of my low back. i was denied two days before my surgery. i have my doctor did a peer to peer review i did a written review and a external expedited review and every one was denied. i have gone to five doctors for different opinions. my back is not considered to be unstable so that is why i do not qualify for surgery even though my two disco grams i have had have been positive.
I wish you the best of luck with your insurance for me it is a losing battle. i have been fighting this losing battle for two months know. i am almost out of options. I hope and pray that there is help mout there for us who have pain that is real. keep fighting and do not give up.

Thank you everyone for your replies. I spent 2 days writing my appeal letter and everyone thought it was perfect. My surgeon's office has sent everything over so we will see what happens. I am going to paste the letter here for you guy's to read so let me know what you think!

To Whom It May Concern,

I am writing this letter in response to your denial of my back surgery scheduled for October 12, 2010 with Dr. Todd Doerr at Spine & Orthopedic Specialists. I am requesting that you read this letter and all the other letters I have provided for you and reverse your decision. I have spent many years suffering from lower back pain and I have finally found a surgeon who gives me hope and a possible chance at regaining a normal life.

My last MRI taken in March of 2010 clearly shows 3 discs in my lumbar spine as being severly bulged and torn. I have also been diagnosed with Degenerative Disc Disease, Lumbar Spondylosis, and Lumbar Disc Displacement.

I have tried to avoid back surgery for years but from all of the MRIs, X-Rays, therapy's, medication's, and injection's, I am not getting any pain relief but in fact the pain is getting worse by the day. My back is not going to get better at this point, it can only get worse. But there is a possibility of pain relief, and it is called MIS TLIF (Minimally Invasive Spinal Transforaminal Lumbar Interbody Fusion).

I was let go from my previous job at an animal hospital due to my health issues. They stated that they needed someone healthy to work there and I was not at the time due to my back issues. I was unable to perform the basic duties of a receptionist because I could not sit for long periods of time without being in pain. This problem is interfering with all aspects of my life, I am limited in my physical activity, I am afraid to bend down to even pick up a piece of paper for fear that my back is going to give out and I wont be able to move for weeks, I am on so many different medication's that I am not able to drive and need to depend on friend's and family to take me to Doctor's appointment's or any other personal errand's I may need. I spend every single day of my life in my home. I used to be able to go out with friend's and visit my parents house every weekend for dinner and now I am unable to leave the house not only because of the pain I am in, but also because all of the pain medication's I am taking make me very lethargic and depressed.

I continue to have such strong pains that at times I cant walk for days and am confined to a chair or my bed. I have gone back and forth to many different doctor's to see what can be done and have had no luck but given more medication's and a lot more frustration. How am I supposed to lead a normal life if I am in so much pain all the time? How am I supposed to return to full-time work if I never know from one day to another whether I will need to take time off because of my back giving out? How am I supposed to do anything close to normal if I am taking pain killer's everyday just to get out of bed and take a shower? I am only 32 year's old and I have been forced to become someone that can't even leave my home due to severe back pain.

So far all of the care and physical therapy has not helped reduce the pain and at this point surgery is my only option. As I stated before this problem has cost me my job, friendship's, and basically a good quality of life. Unless I get this corrected I am not able to commit to a full time job for fear of having to take sick time due to not knowing when my back will give out or my legs will start hurting or go numb. I am continually unable to sleep. I am lucky if I get 3 to 4 hours a night and this cannot continue. I need to get back to some sort of normal life with a good job and right now this is not possible.

This whole thing has been very frustrating for me. I have been referred to a pain management specialist, Dr. Allan L. Rowley at the Spine Institute of Arizona. He has tried several methods to relieve the pain but to no avail. He has changed my medication's numerous times due to the fact that some are ineffective or some are too strong and they make me physically sick. Once we find one that relieves the pain, it needs to be changed again.
As soon as it starts helping, my body becomes tolerant and I then need to start all over again. I have a $40 copay for each visit and I currently need to see him once a week. That's $160 a month just for office visits. Then I need to fill the prescription's. In the past two month's I have spent over $600 just on medication's. All of this without a job. My husband is working full-time and we were already living paycheck to paycheck without my back problems. How can a person live this way?

Due to the above facts, I do not understand why you would deny a procedure that would definitely relieve some of the pain, help me get off all of the pain medications which arent helping, and give me a chance at a normal and functional life. My husband and I were planning to start a family but with my back problem not getting any better we are not able to do this. The surgery would actually help me if I were to get pregnant. I have had shots that have not helped, and had to go through so many tests and exams that it has only aggravated my symptoms even more.

How can you possible deny me this surgery when it is the right thing to do? I am requesting that you reverse the decision and approve this surgery so that I can go on with my life and find some relief from all of this and start living. I need to return to work, spend more time with family and friend's, get back to physical exercise, be able to lift items more than 5 pounds, and eventually start a family.

At the rate my back is going if I dont get this operation I can very well end up in a wheel chair unable to walk, work, have children, and eventually be forced to go on to disability which is something that I dont want to do. As I stated before I am only 32, I am very young and I want to live life to the fullest, that is something that I am not able to do and you can help me achieve these goal's.

I would appreciate a second chance on your decision and allowing me to have this surgery as planned and hope and pray that you can see through all of the above exams, tests, and therapies that this is the only recourse that I have at this time. You can give me a chance at a new and better life.

An expedited reversal of your denial would be greatly appreciated and I thank you in advance for reconsidering and approving this surgery.

Thank you for your time~

I recommend you also send a copy of your letter to your states' insurance commissioner, along with a request that they intercede on your behalf. Hopefully this will help you. Wish you well!

Genyle hugs, Lorraine

Insurance is such a pain! Sorry to hear. Maybe they can re-code the surgery and sometimes that gets the approval and many times if your doctor is very persistent with AETNA, they sometime come around and pay. I have them, which plan, may I can help :)

Aetna did the same thing to me when I needed a cardiac cath, as my legs blew up. my dr said to show up early the next morning at the hospital he works and to tell them that I have chest pains. The plan was they would have to do the cardiac cath as an emergecy.
In the end, when I saw my EOB online, Aetna had denied reimbursment for the procedure and the hospital lost 38,000.
I was never contacted about this. I let it die.
Not my poblem anymore and I will remain silent!!

if I may ask why are you pushing so hard for spine surgery. Is your spinal cord impacted and at risk to become palyized. Or have you tied every shot and med under the sea and nothing has worked. I am just wondering

hay casinocat Im so sorry about your inch problums but I would changs inch companys so fast it wouldent be funny and isent there a place were you can reporte them? if its through a company tell them to changs it or just get your own man that would make me so mad I dont know what Id do eather but good luck to you joyce

i work for a hospital and i see patients in such pain everyday. These evil empires (insurance companies) hold peoples lives in their hands and they don't care. People pay their hard earned money every month and then when they need health care people who make six figures deny our claims. A doctor will order an MRI on a patient to see what type of back injury a patient has. the insurance company will deny it saying the patient need physical therapy first. NOW does that make any sense at all. Put the patient through physical therapy and maybe cause further damage before having a test to see how bad it is to begin with. But these insurance companies, the CEO's get huge bonuses if they keep the amounts of the claims down. It's sick and its evil and its wrong. There is no heart and there is no compassion.