Spinal Fusion Surgery nightmare

LATEST UPDATE AS OF OCT 17th

I am posting this update and details below outline what I've been dealing with and how finally, a resolution was near, but then, you know how I always say, " Life throws us curveball " and we never know which direction to take that ball, well I've been thrown a hell of a ball.

On 9/24th I received a text message from my group health insurance that my spinal fusion at the out of network hospital with out of network surgeon had been approved. I was so relieved but to be safe, I called to follow up with a verbal "YES, I'm covered" Before I proceeded to arrange my hotel, transportation, friends flights for after care and began purchasing all the recommended supplies to have a successful recovery.

Following the call for confirmation came a total of 18 approval letters dated sept 27th-Oct 7th covering the surgeons, hospital, hospital stay, hardware etc) HOWEVER, Monday Oct 7th at 6 pm my surgeon called me to inform me he had received an email from my insurance telling me that my surgery was denied. I said, there must be some mistake.It can't be, I've got over eighteen letters approving everything. I will call them first thing in the morning.

My call revealed that although my medical insurance "group" has approved everything, my insurance, Molina Health Care was denying it, saying I needed to use an in network surgeon. Even my medical group got on a 3 way call with me, to get clarification of why the denial, their response " you can file an appeal".

Why would they approve surgeon for me to see out-of-network in the first place 9 months ago?

Why would they allow me to go up-and-down to Irvine to see this surgeon?

Why would they let me go and meet with the vascular surgeon and approve that?

Why would they allow me to get the blood work done for the pre Ops?

I asked them, did they just think I wanted to hang out with a neurosurgeon in my spare time for fun? I was beyond livid!

After filing a 72 hour verbal and written appeal and my surgeon scheduled a peer to peer with molina, they then say they will reverse the denial and will have the medical chief officer sign off on the reversal.

BUT NOPE....

Follow up calls inquiring on status followed with a call from my surgeons office saying they approved " HALF THE SURGERY AT AN OUTPATIENT CENTER " .....FOR SPINAL FUSION!! THEY HAVE LOST THEIR MINDS.

Then my surgeon said that's impossible as its a 2 part surgery to which now the final decision Denying my whole surgery!

I'm infuriated that I've being put through this. I even requested 8 weeks ago for my primary to refer me to an in network surgeon for a 2nd opinion & that still has not been approved.

I reached out to that surgeon and another one to check availability and both are not scheduling any additional surgeries until 2025.

I refuse to start all over again and I will be seeking new insurancecand oursuing legal action to MOLINA.

I am now home recovering from surgery in Tijuana Mexico.

DETAILS BELOW ON MY SURGERY

SO i have confirmed my surgery in Tijuana Mexico with thd neurosurgeon and their team. I leave October 28th for 10 days to 2 weeks in Tijuana and $25,000.

My emotions are truly all over the place. I am in so much pain as not only the lower back pain but if you read below, my left side of my neck has a compressed nerve shooting down my bicep into my wrist and I'm left handed. I can't lift my arm and I don't know what hurts more and this issue has not even been addressed yet.

I am not the 1st or 100000 person that Molina has done this too, apparantly this is their "norm".

I HAVE NO WORDS. IT SICKENS ME.

Anything helps to cover this cost as im borrowing from family so I can get better and have my life back.

MY STORY BELOW

Many of you know what I have been going through medically for the past 4 years, others may be unaware.

Details are included as maybe some of my contacts have been through these surgeries and can shed some light as I'm a nervous wreck.

It began with 4 years of lower back pain and the only diagnosis I received, was " you have a broken back. You must have injured yourself as a figure skater but dont worry, we can fix it without surgery."

Well. Another year passed trying everything from injections, physical therapy, chiropractic (3 different ones) and no improvement.

I then was finally given the actual diagnosis, bilateral pars defect in layman's terms your spine is fractured and I began my research.

I thought I figured it out. I found a newly FDA approved device, that was less evasive and would not jepordize my spinal movement. I then met with the surgeon responsible for getting this device FDA approval and he notified me that I was a candidate but that insurance would not cover this procedure. TOTAL COST $62,000. I could not afford to do it and my search for options continued.

HOWEVER, 6 months later I reached out to the CEO of the device who said a surgeon in California would take my insurance. I WAS ECSTATIC!

When I finally got my primary Dr to refer me to the surgeon at UC Irvine who was out of my insurance network. I then had to convince my insurance that only 4 surgeons in the US are trained on this device and got them to approve the referral. 3 months later I drove to Irvine and was so excited I was close to a chance at recovering. BUT I was devastated when he told me my spine had moved to far and the device will not work for me.

My only option presented to me was FUSION (procedure called ALIF) through my abdomen with a vascular surgeon then over night in the hospital and then CT scan another night in the hospital and then back under anesthesia to be flipped over and screws inserted on both sides of my spine.

While waiting for once again, Insurance to approve two Surgeons and this procedure, I was admitted to ER with no feeling in my left arm, my calf swollen, hot and cold sweats and an excruciating stabbing pain in my neck. 10 hours later: THE RESULT: I have a bulging disc in my cervical spine at C3 C4 ( and I forgot to mention) Feb 20th I had two discs replaced at C4 and C5 in my cervical spine now I was being told by ER I would need additional surgery to repair the disc on top of the risky lumbar surgery I am still awaiting approval on.

I was released from ER and contacted my surgeon at UCI to update them on what happened at the ER only to be TOLD by his staff that, "They can't help me with my cervical spine they are only my surgeon for my lower back. WTF! who then is my surgeon for my cervical spine?

This has taken an emotional and physical toll on me. Those of you who have seen first hand what I have been dealing with, I can't believe it took over 4 years to diagnose me and fingers crossed, maybe I am now finally on the road to recovery.

More fighting with insurance & FINALLY THE DATE WAS SET. ( OR SO I THOUGHT UPDATE IS ABOVE) Scheduled for my birthday , Oct 24th and Oct 26th two part surgery, followed with 5-7 days in the hospital and then 3 months of rehabilitation.

I am being told I wont be able to do any type of physical labor for at least 3 months, and can not travel until 3 month clearance. In addition, sitting, standing or walking for prolonged periods will not be feasible until my 3 month post check up to confirm spine has fused. I was denied temporary disability & unemployment and NOW an additional cost of $25,000 for surgery in Mexico.

Anything helps honestly $1, $5, anything.

I'm trying to remain strong but I'm not going to lie, I am scared to death to get Spinal fusion done in Mexico but I'm also not going to continue to allow this American health insurance to "dick" me around. ITS ENOUGH!

Thank you for reading and I am beyond appreciative and grateful for you reading my story.

With ❤️

Coralyn