Personal Experience with Insurance and Medical Providers

Don Beaver, Fitness Director

Please allow me to illustrate this article with my recent personal medical journey with local providers in an effort to help you should you face similar events. Note: Names were not included in this story for obvious reasons.

The pain from a back injury began in January 2023 and intensified over the next three months such that medical advice was sought in April. I felt that the issue was a pinched nerve, given the location of the pain and the fact that chiropractic adjustments had provided no relief. Nonetheless, in May, X-rays were ordered to rule out joint issues, which they did. The month of June called for an orthopedic specialist who prescribed steroids that proved to be ineffective. Next up, the insurance company insisted on physical therapy (PT) sessions in July, which I argued made no sense given my belief that my issue was a pinched nerve. After several unproductive sessions, the PT manager agreed with me and released me for the next step—pain management—another waste of time. Pain management prescribed three epidural injections to be administered throughout August and September, which were also ineffective. Finally, in October, I was granted my wish for an MRI, which confirmed my (six-month earlier) self-diagnosis that a pinched nerve was the elusive culprit and surgery was required to fix the problem. Due to the holidays’ effect on the surgeon’s calendar, the corrective surgery could not be scheduled until mid-January 2024—a full year after the initial injury.

The surgeon, hospital, and outpatient surgical procedure earned exceptionally high praise for the entire surgical experience. Unfortunately, due to the lengthy process of jumping through numerous insurance hoops and endless months of limping with a pinched nerve, the affected leg experienced muscle atrophy, and, again, physical therapy has been prescribed to strengthen the leg as I learn to walk properly once again.

What is the point of this story?

• Learn from my “too-long” experience and my mistakes.

• Do your best to expedite the injury diagnosis in an effort to get on the road to recovery as quickly as possible (i.e., if you believe an MRI is necessary, be demanding of your insurance provider).

• By no means should you ignore medical professionals, but be aware that insurance companies often seem to have a specific step-by-step “game plan” for all physical ailments, and speaking frankly, that “one size fits all” mentality is not in anyone’s best interest.

• Most of all, do your research. Ask informative questions and hold the professionals and insurance provider responsible for providing proper responses that truly and effectively address your health issue(s).

Most of all, let’s enjoy the journey!