Hi,
I was having trouble getting my radio frequency ablation of the SIJ’s I am already a month overdue, I had a great doctor but is just to busy to see me, not really Pain Management if they don’t treat you! They were not able to do the treatment for another 5 weeks, I had already waited a month to schedule the procedure.
So I found another doctor, he is the only doctor in the practice, he was very relaxed, He said his practice is growing but not that fast, because he screens the patients closely to weed out the ones that had trouble with their old doctor, mainly to do with opioids. Since I am not seeking opioids and looking for alternative treatments we were on the same page.
He said “you came just at the right time, I just bought a RAF unit” he was having to use a different location before. Another thing, my old doctor was trying to do the sides at different times, I was concerned about extra radiation, the new doctor agreed that it is just to charge insurance more, and he will do both sides at once.
Does anyone use a Pain Management doctor for pain from PsA or related illnesses?
I’m so glad you found another that you rate and like. Here in the UK I’ve heard of lots of people being channelled towards a Pain Management doctor but I’m not sure that they get along with it that well. It appears to be used as a substitute for prescribing proper meds and/or pre-diagnosis. So that by the time they actually get diagnosed things have progressed badly for some of them.
Jon, pleased to hear you are getting what you need. Here we have pain programs, rather than pain docs per se.
Mostly supposed to be the pacing, exercise, diet stuff as I understand it. Seems like after listening to the advice on this forum, I’m not really the target - so when I went to see the pharmacologist, she recommended MORE opoids
I guess I don’t take many at the moment, but given we are having the same “opioid crisis” as allegedly in the us, and they have just removed all opioids from over the counter… I was somewhat surprised! We’ll see, with the Cimzia my arthritis has been near non-existent, so it’s supposed to be a flare management plan. Perhaps it will be years till I find out!
I am scheduled to get the Radio ablation of the SIJ’s this Wednesday, I got a letter today being denied by the insurance company, the doctor that denied me is named
Dr. Salami, I would love to get in touch with him and threaten to make a sandwich of him, if he doesn’t approve it!
They are saying it is not medically necessary, I guess I have been getting the ablations just for fun for the last 3 years? I wonder if Dr Salami knows that the nerves grow back and the procedure has to be repeated? I wonder what country Dr Salami is living?
I guess the next approach will be to go back to the spinal surgeon and see about correcting the problem, they don’t leave me much choice, as the war on drugs have taken away that option too… Sounds more like the “War on Pain Patients” to me…
I’ve worked in insurance for 25+ years. I assume the procedure was covered before? If so odds are good there was an incorrect Diagnosis Code (ICD 10 code) on the submitted paperwork.
Another thing that’s happening right now is that insurance companies are cracking down on incorrect billing and fraudulent procedures. In reality this is a good thing but sometimes innocent people get caught in the correction.
First thing you need to do is double check how to produce was submitted to the insurance. If the office said it was “voluntary” instead of “medical” you have a problem there as well.
Next thing you want to do is find out how to appeal. That info should have been provided on the back of the denial letter. Most private insurance in American have 3 levels of appeal. It’s not difficult to do at all, you just need to explain what’s happening to you and your history of success with this procedure.
Actually, come to think of it, it could be that your insurance covers it (for example) every 6 months and the paperwork was received during month 5, causing a rejection. Call your insurance and find out what the actual coverage is, there’s a member services number on the back of your ID card. It could be that it can be submitted next month and covered.
Let me know if you have problems or questions, I’ll be happy to help you get this straightened out.
thanks, they claim that it is a unnecessary medical procedure, saying there was no submitted proof that it was serious enough to cause me not to be able to work. It has been almost 8 months since I had the last treatment, so I am 2 months overdue, because of the insurance approval. the nature of the treatment is such that as the nerves regrow, the pain increases…
My last Pain Doctor tried for 20 days then gave up, my current pain doctor submitted it, and it was rejected, she might have appealed it already, I will find out tomorrow if we can proceed with the treatment scheduled for Wednesday morning… If they will not approve I will pay the cash price, they only pay out $570 for bilateral treatment, even though $4,000 is billed.
Everything went well, the Pain doctor did the ablation all the way up to L3, my other doctor just focused on the SIJ and my extra L6, we shall see…
Then in the afternoon my remicade infusion also went well, barely made it home before I collapsed. It was a good day…
Had a follow up with my new Pain Doctor, the RFA of the SIJ’s didn’t work, when I told him, he said he did not do that area! I had went to him to do RFA of the SIJ’s… He stated that he could not do it, as it would be unethical and he could be audited, but isn’t it unethical not to tell me, the patient? He did kind of had a look like a deer in the headlights…
This treatment was done for two years with my old doctor, he got it approved with insurance once, I don’t know what he told them, my new doctor claimed there was no notes on it. I have a copy of the Visit notes online, but didn’t have them at the office visit.
He is going to give me a cash quote to hit the SIJ’s, since he has the equipment in house, I mentioned the other do tor was charging $500, and insurance was only giving him $570 for it, he got quiet on that…
He did agree to get imaging of the Thorasic Spine where it meets the Lumbar, maybe he can get permission to treat that… With me it is pick a spot, any spot. But the spine os the most painful.
I am so fed up with insurance companies and doctors…
