I'm located in Illinois and want to say thanks in advance for any suggestions anyone may have>>> I got hurt back in Jan. of 2004 and have had a cervical fusion done by insurance company doctor in 2005. He put me at MMI 2 months after surgery but said cannot return to my boilermakers position. But he did say that I needed another opinion and suggested to the insurance company a name of an ortho who he said may be able to find just where the pain generator was in my neck because he for sure is still scratching his head and cannot figure out what is wrong with me. But post surgery he did say I needed possibly C4/5/6/7 all fused in the very near future. He did C4/5.. Before this there were 3 other doctors that said similar to what he said as in C4/5/6/7 but both the others said that C6/7 should be performed 1st because of a structural design of the spine or that you work up a spine and not down a persons spine when there is multiple disc problems etc. I wanted to use my doctor but the insurance company said that they would not consider paying for a study type surgery of disc replacement. But this is what I originally wanted to have done b/c he told me if this replacement does not work you can always come back and have it fused which is what these other two doctors were going to do anyway. So the I/C put it to me this way if you dont have our doctor do the fusion then you are going to be considered MMI and you will be cut off of all benefits. So I went ahead and let their doctor do the surgery. Keeping in mind I was about to lose mine b/c of the pain I was in. I was lucky to get 2 consecutive hours sleep per night and this was every night. But anyway after he put me at MMI he wanted me to go to another specialist b/c he couldnt figure out what was wrong with me. So the I/C kept delaying it and about a year later they tell me they have a doctor they want me to see and told me his name etc. gave me directions and the date etc. So then about 3 days before my appointment that was at least 3 months getting into his office.....they call and say he will not look at me b/c I have been seen by 3 others and they all have about the same idea and he just thought giving another opinion would only muddy the water and get me more confused etc. So I figured after this the I/C would set up another IME. But to no avail. Then last July the I/C sends me a letter and are saying they want me to talk to these vocational rehab people and they set up times and appointments to meet me and we did. Meanwhile I had set up another doctors visit with the only doctor that was truly on my side or who was in my corner I felt if you will. He says to me that he couldnt believe I never came back and had the replacement done and was shocked that I had this other done. But he said I'll not be a part of the baggage that has been placed on you by this other doctor and not take any responsiblity for it whatsoever but he says you still need C6/7 done by replacement and this other doctor should have done C6/7 first b/c of a structural outcome of long term surgery of this magnitude. I told him I tried coming back to you and the case nurse told me before we left your office that the I/C would not pay for a study type surgery and that was final. I think to this day he thinks I'm kidding about this but if he only knew that the insurance company was going to cut my funds off if I didnt have the fusion done and if he only knew how hard it would be to feed my (8) kids without a check coming in then he would understand that they had a squeeze on me like you cannot believe. But anyway he set up a disc replacement surgery and I did all the pre arrangements with the hospital etc. and had everything ready to go into the hospital and I called my case nurse to let her know I was ready to go and had all my pre-op set up and she said wait a minute your adjuster called and said that the insurance company has just said they are not going to authorize the surgery and they are sending me to another opinion of their choice etc. Then my doctor wrote me a letter saying he will not be able to treat me anymore. The I/C told me that my doctor changed his mind a day before the surgery and said he didnt think now I needed this surgery? I have asked him many times and have called his office to discuss this with him and he will not give any reasons why he changed his mind and will not even say that he did in fact change his opinion other than to send a letter and say that he will not look at me anymore and that I'm not under his care anymore. I'm only thinkibng that the I/C has made him mad enough now that he does not want to mess with me b/c he knows that the I/C is nothing short of confused for sure and they are gasping for air is all I can think. I mean what kind of a doctor changes his mind a day before this magnitude of a surgery? Life long life lasting surgery. It all make no since at all would you agree? Then I wait another three months for the I/C to get me another opinion and then after waiting another 6 months this doctor decides a week before my appointment that he cannot see me either? Is this not off the wall or what? Now they are using this vocational rehab company trying to get me a job at $7.50 per hour. I was making right at $40.00 per hour. How can this be gainfully employed? This is what they are saying they are trying to get me at this point to where I'm gainfully employed. Is this gainfully employed? How does this work? Will they cut my w/c from $1000.00 per week down to me making $300.00 at Mcdonalds and thats it? What in the world is this? What kind of settlement might they have to pay or what is the maximum amount they will get by with paying me here. Do they give me a differential of say they would owe me $400.00 per week for the rest of my life and figure so much until life expectancy of another 25 years and come up with a figure that way? Heck the pain management doctor that my surgeon has me going to has said he thinks that a morphine pump very soon is inevitable. Can a person really drive to a job that is 50 miles from their house while on these types of drugs? I'm on the highest pain meds possible right now of percocet or oxycotin 10's. How can a person even be expected to stand on his feet for 8 hours much less drive in traffic during the rush hours etc. Heck trust me if I could I would go back to work today but the thought of having a head on collision with a family b/c of these meds has me worried to death. I took my daughter to school one day when her car wouldnt start and somewhere in between my house and school my daughter was tugging on my shoulder yelling at me that I fell to sleep. Needless to say I have not driven her back to school since that day. This is horrible but it is reality and I was thinking wow what if this doctor says next that it is time for the morphine implant? Unreal thought here and I just wish I never went to work that day. I could have fallen over 600 foot and I broke my nose and messed my knee up and cracked my neck and also messed up some disc in my neck like I said C4/5/6/7... I guess I'm lucky to be here but I dont have a death wish and would hate to crash my car just because the insurance company is trying to get away from this case as cheap as they can. Anyway can anyone give me some kind of idea what I can expect thi is worth. How does the wage differentials work and how does the life expectancy thing work? Should I just ask the I/C to settle and go ahead and retire b/c I have enough time in the union and could retire now that I'm down to 5 kids at home now. Any help with this would be appreciated. Please email me at if you want at
houstonsalamo@msn.com and thanks so much. I just wish the pain would go away and not have to live with this pain anymore. I have spoke to a lawyer and she told me that if I hired her she would start a 19B and get a 30 day hearing with an arbitrator and make the I/C pay for a 2nd opinion because there is noway a doctor would change his mind a day or 2 before post surgery. To her the I/C has done some fishy things and she thinks that by going to an arbitrator she could get some statements from all the doctors above and the I/C might be in some big trouble by not giving me the proper medical treatment that I have been so long in dire need of. Thanks for anything anyone can tell me or any advice anyone has. Stan
Doctor Recommended Disc Replacement But Insurance Denied Surgery
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