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Caution is Imperative – a Rationing of Healthcare

This Patient Protection and Affordable Care Act, aka Obama Care, Medicare’s Limited Coverage Determination and our current insurance environment has become a rationing of healthcare for the patient.

If you’re a patient with spinal stenosis or spondylolisthesis, your ability to just get an MRI scan is already being denied, delayed and deluded.

Let me explain what lumbar spinal stenosis is – it simply means that the part of the spine that starts where the ribs end down to the pelvis is narrow or stenotic – a narrowing of the spinal canal. If you’re a patient with lumbar spinal stenosis – it very often means that overtime you have developed joints that have enlarged, bone spurs that have enlarged, discs that have bulged and ligaments that have gotten bigger, when you add to that instability or deformity of the spine, you have lumbar spondylolisthesis. Lumbar spondylolisthesis is a slippage or deformity of the spine that becomes problematic because it causes back and leg pain.

If you have been diagnosed with spondylolisthesis, one of the preferred methods of treating this disease process is surgery. It has become inordinately challenging to cross the T’s and dot the I’s to get approval for the appropriate surgical management for a patient that has lumbar spinal stenosis with lumbar spondylolisthesis in the state of Florida in 2013 because of the limited coverage determination’s that are in place with our local Medicare provider.

As an orthopedic spine surgeon, the orthopedic problems that I treat is a huge percentage of the health care problems that develop in patients who are on Medicare, because people who are on Medicare are either 65 or older or they have had some type of a disability or disease process that qualifies them for the federally funded health care program.

It’s a wonderful program; the problem is they say it’s running out of money. So if it’s running out of money that institution needs to protect itself by protecting its money.

We understand that and we support that.

We do. But we also have the responsibility to our patient’s to inform them that caution is imperative.

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