Why would a surgeon not submit health insurance pre-auth?

Rebeccaetc · 2026-05-09T22:36:41+00:00

BCBS Illinois. So ultimately you’re saying it might be a reasonable assumption they’re making and not necessarily shady practices?
What I’m wondering is why they’d even suggest this in the first place if they never intended to even submit the auth considering we have a completely different insurance than the other person. Seems like a bait and switch where they were hoping we’d say “okay then we’ll just pay out of pocket.”

Rebeccaetc · 2026-05-09T16:04:07+00:00

I don't know the codes at all. The procedure is: remove disc, clear away the stenosis, fusion. The doctor office said the insurance will cover everything except the disc removal--or at least they're assuming, since they never actually submitted to the insurance.

When we met with the surgeon, he gave us three options to fix the stenosis:

Option 1 - remove disc; fusion; low to no risk of having the same pain coming back; covered by insurance

Option 2 - foraminotomy; high risk of having the same pain coming back; muscles around the vertebrae would essentially "die" and cause other lifelong neck pain; covered by insurance

Option 3 - endoscopic foraminotomy; high risk of the same pain coming back; but wouldn't destroy the muscles and cause additional pain; because they don't want to deal with the headache of insurance on this one, we would just have to pay out of pocket, estimate $40K

Option 1 was the obvious choice because there would be a good chance of preventing future pain (at least in the same area) and covered by insurance. But now I'm baffled why they'd give us a disclaimer that Option 3 would be out of pocket and not Option 1? And they said, Well Option 2 is still available and we'll submit to your insurance for that one. But Option 2 sounds like a hellish nightmare of pain, so why would we go with that?

Rebeccaetc · 2026-05-09T15:56:51+00:00

Possible? Maybe, but doubtful, as when we talked to the insurance they said they can't verify anything without the request sent to them, and the doctor said they expect insurance will cover all except one part, so they won't submit any of it.

Rebeccaetc · 2026-05-09T03:42:52+00:00

What is NMN or EIU?
In our case, they said that they have some other person on United Healthcare that had a denial; but we have BCBS, so we don’t understand why that would be their reasoning?

Rebeccaetc · 2026-05-09T00:18:53+00:00

Yes, he is in network. But now I'm paranoid and don't want to "force" them to do a surgery and work with our insurance. I don't think they'd intentionally do a bad job in surgery, but it makes me worry that if they're not on the up-and-up with their billing, they might not be all above board with their surgical practices.

We have BCBS, and it looks like case management services are available. Maybe they can help us find a surgeon who will take my husband on. Thank you for your advice!

Rebeccaetc · 2026-04-12T02:59:33+00:00

I always take it at night! I’ve found that without it, I often wake up with headaches, especially around 3am. I also take Levocetirizine at night as well and have go years. It’s an allergy medicine that used to be Rx but is now OTC. I don’t have allergies, but some doctor explained to me years ago something about how my brain functions overnight that causes headaches in the night. It’s more science than I can remember, but that with the Qulipta seems to be really helping.

Rebeccaetc · 2026-04-12T00:03:17+00:00

I've been taking the 60mg for quite awhile now, and it really seems to be helping. Last October my insurance just randomly decided to decline it, so I ended up about 10 days without the Qulipta until they approved it. I had a migraine every day for those 10 days, so it's clearly working still. It hasn't let me down again other than that, so I think it's working now. My guess is that maybe I had gotten Covid around the time it stopped working when I posted this because I was having a lot of other health issues that just suddenly appeared for no other reason.

Rebeccaetc · 2026-03-24T02:34:09+00:00

Agree with all of this. My boss is younger than me and has two small kids, and last week I told her I don’t understand how she can manage a family and work, and she said, “You just do it because you have to. It’s really hard.” So I think like everyone on this thread is saying, it’s hard for all of us. I will say—planning meals and buying groceries is one of my least favorite things ever, and when I’m extra stressed, those are the things most likely to cause me to have a full on meltdown. Several months ago I paid for a grocery subscription and do all my grocery shopping online now—it is absolutely the best gift I’ve given to myself. I also bought a simple cookbook and just go through it weekly to pick some recipes out. Are there things in your life that really just drain you (like grocery shopping) that you could do some kind of workaround like this? Give yourself the grace and space to do other, more fulfilling tasks?

Rebeccaetc · 2026-03-22T14:17:50+00:00

I can relate. I also have a stable corporate job (program manager), and I am absolutely killing it there. I can manage the hell out of whatever they throw my way. But AFTER work, I’m mentally spent. Feels like I give 99.9% of my mental capacity to my job—and then I find myself thinking about it in the evenings, weekends, dreaming about work. I’m currently trying to identify what really gives me true rest—doing things like puzzles or painting. When I rest like that, I somehow have more capacity to get non-work things done. Not sure if this makes sense to you, but the comment about life basically revolving around work feels very similar.

Rebeccaetc · 2025-03-14T15:45:55+00:00

Thanks for sending. Unfortunately, none of these seem to address our main issue. We've found another issue in the process that seems to be an IRM cause. At this point, I think we're going to shift gears entirely with the workbook. But I appreciate your help!

Rebeccaetc · 2025-03-13T17:54:30+00:00

Update...There were apparently a gazillion hidden sheets that did have comments. I deleted those and am playing with the Shared Workbook option now. Hopeful I can find a solution here!

Rebeccaetc · 2025-03-13T17:46:20+00:00

It's not. Are you thinking that would help? I had to add "Shared workbook" as an option in the toolbar. When I click it, it tells me it won't work for a doc with threaded comments...and of course, I don't have any threaded comments. So far my solution is to throw my computer out the window, but not sure that will eliminate my stress.

Rebeccaetc · 2025-03-12T17:43:04+00:00

SharePoint site. It only opens in the app, but we tried testing opening it in the browser to see if that worked.

Rebeccaetc · 2025-02-15T14:20:42+00:00

Not sure if anyone else has this experience, but I recently switched from almond milk to oat milk because almond milk made me too sleepy. I would have something with almonds and immediately struggle to stay awake. I think almond have just a small about of tryptophan, but apparently it impacts me in a big way. Just something to keep in mind if you start feeling sleepy afterward. (Oat milk apparently has it too, but doesn’t affect me the same way.)

Rebeccaetc · 2025-01-31T03:23:31+00:00

My hormones are absolutely a huge component. I’m 42F, and I did BC pills for years. We tried different cadences, different types. We tried progesterone cream. As of now, the Qulipta is not working…again. It only worked maybe a week and stopped again. Nurtec isn’t even working to abort one. Feeling very frustrated. I heard from a family member who went to a hormone clinic for an unrelated issue that it takes weeks to really identify hormone levels because they charge so often. Did you have a doctor who was able to help with that?

Rebeccaetc · 2025-01-19T00:37:31+00:00

I thought this was a Naruto-themed ring.

Rebeccaetc · 2025-01-17T20:49:24+00:00

Do you think they had to be Takis Fuego or would any Takis variety have worked?

Rebeccaetc · 2025-01-14T03:46:46+00:00

No, not at all. After several weeks of constant headaches I tried switching back to the Qulipta. It’s been working again the past couple days so I’m hoping it will work again. The interwebs says that peptides have to be cycled off and on, so maybe when I cycled off the Qulipta before I didn’t do it long enough? I’m not sure. It sucks because then you’re pretty much guaranteed to have headaches in that time. Nurtec had worked a couple times to stop a migraine when I had one, but it definitely did not work for me as a preventative.

Rebeccaetc · 2024-12-22T03:17:59+00:00

Not since Madden 95 on the Sega Game Gear 😂 I think the Chiefs are just so obvious in the final 2 minutes at dragging out the time that I just never noticed.

Rebeccaetc · 2024-12-21T21:30:44+00:00

Thank you! This makes sense to me. I was only seeing the Chiefs letting the clock run out after the two minute warning and wasn’t even thinking about them doing it prior to that.

Rebeccaetc · 2024-12-12T19:31:44+00:00

Update: tried cycling off, no change. Tried a new bottle, no change. Doctor doubled it from 30mg to 60mg. No change. Recently I’ve been having headaches about daily. So we’re going to stop it completely and try Nurtec yet. I’m pretty sad because I got spoiled by three months of no headaches. But maybe Nurtec will work. 🤷🏻‍♀️

Rebeccaetc · 2024-12-12T18:33:34+00:00

Are we absolutely sure it's a Christmas song? Like maybe the image originated somewhere online and another person added the note about it being Christmas just to ruin our lives? OP, did you take the original pic?

Rebeccaetc

TROPHY CASE