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I've had the facet injections several times. Unfortunately, it's been a number of years so I'm not sure if my Medicare paid for the entire bill or my BCBS (FEHP) picked up the rest. At any rate, I didn't pay anything. I will say that the effects (pain blocking) lessened with each succeeding injection, significantly enough that after the 4th round I stopped them. I still have neck pain due to cervical spondylosis and occipital neuralgia but manage it with Voltaren gel, ice packs, and muscle relaxers. YMMV.
I've had the facet injections several times. Unfortunately, it's been a number of years so I'm not sure if my Medicare paid for the entire bill or my BCBS (FEHP) picked up the rest. At any rate, I didn't pay anything. I will say that the effects (pain blocking) lessened with each succeeding injection, significantly enough that after the 4th round I stopped them. I still have neck pain due to cervical spondylosis and occipital neuralgia but manage it with Voltaren gel, ice packs, and muscle relaxers. YMMV.
Thanks for the feedback! Medicare billing has been an ordeal for me recently - someone failed to correctly code a screening blood test I had back in 2019 and Medicare wouldn't pay it because the code that was submitted was for a diagnostic test for someone who has cancer. I don't have cancer and so, Medicare said the test was "Medically Unnecessary". I contacted them and explained that the testing lab had submitted the wrong code ... they said I would have to contact the lab and have them resubmit with the correct code. When I contacted the lab, they dug in their heels and said they couldn't change the code on my say so and wanted me to get my doctor to contact them with the correct code (of course, they wouldn't pick up the phone and make a call).
Any way, this went back and forth several times and I think it was finally resolved after a year and a half! But, it's still too soon to know for sure. Some hot shot young accounting major is likely to find the old, incorrect billing transaction and start it up all over again.
So, with this recent spondylosis diagnosis I'm getting sent off to see various specialists and undergoing different procedures - everybody is quick to cut orders but no one seems to know much about billing, coverages, and especially Medicare. If I got all balled up for a year and a half over a simple blood test, think what they could do with all this stuff!
From what you're saying, it sounds like I may be able to ride OK - I've also got BCBS (of Texas), it's a high deductible, Plan F but, according to their coverage documents, it looks like once I've met their deductible, they will pretty much cover anything else that comes along - at least for the rest of this calendar year.
Thanks for the feedback! Medicare billing has been an ordeal for me recently - someone failed to correctly code a screening blood test I had back in 2019 and Medicare wouldn't pay it because the code that was submitted was for a diagnostic test for someone who has cancer. I don't have cancer and so, Medicare said the test was "Medically Unnecessary". I contacted them and explained that the testing lab had submitted the wrong code ... they said I would have to contact the lab and have them resubmit with the correct code. When I contacted the lab, they dug in their heels and said they couldn't change the code on my say so and wanted me to get my doctor to contact them with the correct code (of course, they wouldn't pick up the phone and make a call).
Any way, this went back and forth several times and I think it was finally resolved after a year and a half! But, it's still too soon to know for sure. Some hot shot young accounting major is likely to find the old, incorrect billing transaction and start it up all over again.
So, with this recent spondylosis diagnosis I'm getting sent off to see various specialists and undergoing different procedures - everybody is quick to cut orders but no one seems to know much about billing, coverages, and especially Medicare. If I got all balled up for a year and a half over a simple blood test, think what they could do with all this stuff!
From what you're saying, it sounds like I may be able to ride OK - I've also got BCBS (of Texas), it's a high deductible, Plan F but, according to their coverage documents, it looks like once I've met their deductible, they will pretty much cover anything else that comes along - at least for the rest of this calendar year.
I know how frustrating it can be with billing. I had an xray that medicare refused to pay, saying it was related to my accident when that part of my body wasn't affected by the accident. I made a bunch of phone calls and eventually a year and a half later, it also worked itself out, Medicare and BCBS Medigap both paid.
As I said, you should post in the health insurance section, someone may be able to give you a better answer.
04/23/2021 : Howdy All -
OK, I saw the neurosurgeon this week and he had me get a couple more neck X-Rays and set me up with some physical therapy sessions. He also sent orders to the pain clinic for me to have some cervical facet injections (I think these are "block" injections).
[Update]: So, it's been 4 months since I first saw the neurosurgeon and went through several weeks of physical therapy plus two medial branch block procedures and, finally a radiofrequency ablation (RFA) of the nerves in my neck. If successful, the RFA was supposed to remove or reduce the pain and perhaps become a method of managing the pain.
Well, the RFA didn't really do what was hoped - there is a small amount of relief and the area where I was experiencing pain in my neck and upper right shoulder seems to have been reduced to mostly in the neck area only but, every day the pain will build as I turn my head and use my neck. Eventually, I have to lay down for an hour or two and remove the weight off the neck.
So, I went back to the neurosurgeon and expected that he would give some guidance or offer his best advice as to what the next steps might be (surgery? additional injection/ablation procedures? more or different PT?). But when we met he was indecisive and really didn't offer any recommendations - when I pressed him about possible surgical remedies he said that my situation would probably mean a multi-level Anterior cervical discectomy and fusion (ACDF) but that the odds of a successful outcome for this procedure was about 50/50.
He didn't offer any other options and wasn't very encouraging; I tried to get him to comment on other possible types of procedures (e.g. foraminotomy, posterior or endoscopic procedures, etc.) but he wouldn't expand on anything. When he wrapped up the meeting he said that I had to make the decision on whether I want to have the surgery done; if so, then let him know. And that was it - end of appointment.
He was certainly a different person from the pro that I met in the initial meeting; then he seemed to have a well defined list of options that might be tried and it was encouraging to know that there a variety of procedures that could improve things. Now, he was a real wash out with nothing much to offer.
I'm really disappointed - I think I'll go back to my GP and see if there's someone I can see for a 2nd opinion.
I'm really disappointed - I think I'll go back to my GP and see if there's someone I can see for a 2nd opinion.
Has anybody else had a doctor "go cold" on them ?
I don't see this as him going "cold" on you. I see it as a surgeon putting the ball in the patient's court and being honest and realistic about the outcome probability. That's what we all seem to want now, isn't it? Doctors that make patients part of the decision making equation? An end to the paternalistic nature of things? Surgeons who don't want to rush right in to the OR? Well, be careful what you wish for, right?....
I also had spine surgery, but it was a microdiscectomy lumbar procedure, not cervical. I had a disc herniation with nerve root compression at L5/S1 and after 8 months of trying nonsurgical intervention that didn't work (PT, 2 epidural spinal injections, acupuncture, even chiropractor once), I decided to have surgery. And I emphasize it was my decision, not the surgeon's. I went to see 3 different surgeons to get opinions and ultimately decided on guy #1. Also by way of background (because it influenced my initial attitude and decision), my husband is an Orthopedic surgeon and although he doesn't do spine, he did it as required during residency and hated it. His first reaction to my problems was "do not have back surgery.....ever". He based this on the many bad outcomes he saw and the patient population as well, which does tend to be more full of people with myriad health and psychosocial problems than other populations. Well, after a few months in pain, I started to appreciate why spine patients always seem to be so unhappy. They're pain and have done things unsuccessfully to resolve it and that makes you depressed and angry. He has his share of patients like this too, the difference is, surgery is much more likely to help the people he sees, as opposed to spine.
Anyway, I saw 3 surgeons and they all kind of had different styles:
Surgeon #1- middle aged professional, very experienced, did surgery on my Dad a few years earlier. Ultimately, I went with him, but he was very conservative and very hesitant to say "I think you should...". I saw him 3 times before making my decision, but once I did, he was all like "Great choice, I think it will go well, let's do it" And we did. And it did go well. 100% successful.
Surgeon #2- someone in the area local to me. My husband had initially told me he didn't recommend anyone local (he doesn't have a partner that does spine, but knows all the spine surgeons around here). Well, this guy told me right out of the gate that I needed surgery and said I should have had it months before. At the time, I didn't like his style or approach, but you know what, he was absolutely right and wasn't afraid to speak his mind. It was both shocking and refreshing at the same time.
Surgeon #3- a young guy my husband knew at another facility in his health system. Like surgeon #1, he was a "just the facts" guy who talked to me about options, but made it clear to me that I would have to be the one to decide.
So, I went with guy #1 and it turned out great as I mentioned above. But, my long post is really to emphasize the point that surgeons have different ways to approach things and their interactions with patients before surgery really shapes how the patient perceives the process and even outcome. Some people want to make decisions themselves and other people want to be told what to do. Surgeons have to try and thread this needle.
Last edited by Texas Ag 93; 08-28-2021 at 07:41 AM..
Hi there Texas Ag - thanks for your informative reply. It's good to get a sense of proportion in trying to evaluate options - or even knowing what options are available.
That's really the gist of my gripe; I was expecting that I would get an overview of pros and cons associated with any of the options available. The CV of my neurosurgeon indicates a credentialed and experienced professional who has obviously performed cervical spine surgeries for many years. You'd think he might be able to describe surgical options in context with what has been determined through imaging, physical therapy, and medial branch nerve blocks performed on my neck - items he ordered during our first encounter.
In stead, I am presented with a rather non-specific monologue with no measured options; ultimately I am told I have to make a decision to undergo surgery which can go either way with a 50/50 chance of success. That's just a flip of a coin - that's not deciding.
I agree that the surgeons are probably confronted with a lot of stressed out people with multiple health and psychological problems. I can imagine that there may have been patients that have gone completely berserk when presented with bad news (there are plenty of people who go nuts on less serious things). Perhaps this was his way of not presenting me with an unfavorable overview.
OP - I am a physical therapist. I don't have the details of your medical history so I will simply speak in generalities.
All surgeries are risky (some more than others) but when it's about your cervical spine, you're right to try everything else before going under the knife. A "poor outcome" as the medical field so delicately puts it, could mean that you end up much, much worse off than when you started.
You mentioned you have tried PT. May I ask what they had you do during the PT sessions? While you cannot rely on PT to fix the degenerated intervertebral disks, you can strengthen your neck musculature so that your cervical spine is better supported. Also, have you tried a TENS unit? It is an inexpensive way to keep the pain under control and works well for most people. Have you gone to just one PT, or have you tried several? Did you get 1-on-1 attention from the PT during your sessions, or did you go to a "PT mill" which is more focused on sucking the most money out of your insurance than helping you with your impairments? DM me if you wish.
There is a saying about surgeons: "all surgeons know how to operate. A good surgeon knows when to operate. An excellent surgeon knows when to not operate."
That's really the gist of my gripe; I was expecting that I would get an overview of pros and cons associated with any of the options available. The CV of my neurosurgeon indicates a credentialed and experienced professional who has obviously performed cervical spine surgeries for many years. You'd think he might be able to describe surgical options in context with what has been determined through imaging, physical therapy, and medial branch nerve blocks performed on my neck - items he ordered during our first encounter.
In stead, I am presented with a rather non-specific monologue with no measured options; ultimately I am told I have to make a decision to undergo surgery which can go either way with a 50/50 chance of success.
Per the bolded, the surgeon can, and should, be giving you all the information you need to make an informed decision. If he's not doing that, then get a second opinion. In fact, always get 2-3 opinions. As my story above illustrates, I talked to 3 surgeons and they all cast things in a different light.
Quote:
Originally Posted by 2nccoast
There is a saying about surgeons: "all surgeons know how to operate. A good surgeon knows when to operate. An excellent surgeon knows when to not operate."
This comment above is spot on. I wish more people understood this. Many people assume the "to a hammer, everything looks like a nail" philosophy applies to surgeons and they press forward on operating on about everybody. That is absolutely not the case. My husband will sometimes describe another surgeon as someone who "operates on anybody". He doesn't mean that as a compliment.
OP - I am a physical therapist. I don't have the details of your medical history so I will simply speak in generalities...
... You mentioned you have tried PT. May I ask what they had you do during the PT sessions?
Hello,
The PT sessions always involved a few different types of range of motion exercises - rotating my head left & Right or flex/extend forward & back. Some neck bending from head upright to the left or right shoulder as much has possible. Some of these would get pretty painful if I already had w sore neck before the session - so we would slack off it that was a problem.
They also did cervical spine traction; first, they tried a machine that was mounted at the head of a PT table and they'd secure a movable rod to my head by velcro belts. I think it was supposed to apply some sort of pull to my head to slightly stretch the neck but, I don't know that it really did anything. I could hear the machine making noise and feel the velcro belt tighten slightly but I didn't feel any stretching of my neck.
So, we left the machine alone and they did about 10 minutes of manual traction where the PT tech would cradle my head in his hands and give a slight pull every 2-3 minutes. That provided some good results that relieved the pain and would last for the next day or so.
They also put a little electro-stimulator on the back of my neck for a few minutes. That felt pretty good at the time it was running but it wouldn't last very long; the results would fade by the time I was leaving the session.
Overall, I thought the exercises helped to make my neck more limber but I also have "moderate kyphosis" (from years of computer programing and bad desk posture) and was hoping the sessions would help me to hold my head up more. The sessions only lasted 8 weeks so, I might need to continue them to get better results.
Any way, I think the sessions - and especially, the traction - were helpful. I'm hoping I can return to them if the insurance will cover it.
Per the bolded, the surgeon can, and should, be giving you all the information you need to make an informed decision. If he's not doing that, then get a second opinion. In fact, always get 2-3 opinions. As my story above illustrates, I talked to 3 surgeons and they all cast things in a different light.
Thanks Texas Ag,
I have to go see my GP for my annual meeting and will discuss 2nd opinion sources with him then. But, for now, I'm going to go back and get a conference with the doctor at the pain clinic where the medial block procedures and ablation were performed.
Even though the ablation didn't provide the desired results, it did have some effect and this doctor did take time to show me what was going on and provide some insight as to how the procedures were designed and what might be expected. I'd like to talk with him and see if a 2nd try of the ablation procedure might be worthwhile. If not, I'd like to get his opinion as to why it might not have worked - when he was doing these procedures he was viewing my neck vertebrae and facets on a fluoroscope; perhaps he can describe the pathology specific to my neck.
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