“Robin Ginkel is a 43-year-old early childhood special education teacher in Minnesota’s Twin Cities area. In February 2023, she pulled her back as she was picking up a kid, causing a disc to bulge. The pain was and still is extraordinary, and Ginkel has suffered from a significantly reduced range of movement ever since,” Matthew Cunningham-Cook writes over at Healthcare Un-Covered. “Her doctor recommended surgery. UnitedHealthcare says she doesn’t need it, despite the fact that her pain is often intense and she can’t be as physically active as she needs to be for her job. Her surgeon recommended a laminectomy, which removes a portion of the disc to deal with debilitating back pain, and sent a prior authorization request to UnitedHealthcare. A 2015 study showed that most laminectomy patients reported substantially less back pain. Nevertheless, the insurer said it wouldn’t cover it. At first, her surgeon thought the denial was because of a coding issue and expressed optimism that the denial would be reversed on appeal and that the surgery would bring the relief she needed. ‘My doctor said “We know the process, so we’ll just put in an appeal. We’ll recode this stuff, and it shouldn’t be a big deal.”‘ Then the second denial came back.” Matthew Cunningham-Cook, “Her surgeon said she needed the operation. UnitedHealthcare said no.” Healthcare Un-Covered.
