It's experimental? Since when?
January 6, 2014 1:25 PM Subscribe
Questions around experimental procedures, health insurance, incommunicative doctors, and trying to advocate for someone who resists advocacy. I've broken down my big questions with some supporting info below.
posted by anonymous to Health & Fitness (12 answers total) 1 user marked this as a favorite
Okay so I'm feeling pretty overwhelmed and don't know what to do.
This story involves my health insurance co (through work), my husband's surgeon, and my husband.
If an insurance company asserts that a certain procedure is experimental for the patient's condition, how does a doctor go about proving that it isn't?
About the procedure:
The procedure is lumbar spinal fusion and it's for the condition where the cartilage in the disc slips out of bounds and starts crushing a nerve, and then you get surgery where the cartilage is removed and then scar tissue takes its place, then after you lose health insurance for 2 years and then get it back, the doctor wants to permanently protect the nerve from getting impinged on by anything else via lumbar fusion.
How would I, as the patient's advocate, go about confirming independently whether or not it's considered experimental?
The insurance company is claiming it is (I just found this out from them today), and the doctor never mentioned this to me or him, so really I don't trust any one right now. In fact I'm angry at the doctor's office for wasting our time and money and putting him through painful and expensive physical therapy that did nothing to address the insurance company's actual biggest concern. (This anger my hubby describes as "siding with the insurance company".)
Would getting a second opinion from another doctor hasten the approval? Or help me understand what's going on?
Would it be possible or considered ethical for me to ask for his entire file and take it to another doctor if my husband won't be on board with that until I can prove that it will work?
Am I wrong in thinking that the doctor's office spectacularly screwed up by not addressing this with us when we were in last and causing a lot of time and money to be wasted? And that they don't deserve another chance?
I need help and I don't know who to turn to.