Wednesday, September 25, 2013

Ayelet appeals to the insurer

My rheumatologist, Dr. Kind, and surgeon, Dr. Sharp, have both spoken to the insurer to plead for my surgery to be covered. They were both denied, but I was told I could write a letter to the appeal coordinator and plead my case.

I am writing to appeal the decision made to deny my surgery. At this time I am experiencing severe pain on a daily basis, which hinders me as I try to do my job and imprisons me as soon as I get home. I am a social worker in two busy methadone clinics, and it is very painful for me just to walk around both clinics to supervise 16 counselors and see patients. I am unable to stand for more than one minute without significant discomfort; even waiting for the elevator is painful.

I am dependent every day on Tramadol and Lidoderm patches to manage the pain, and it is never fully absent. I wake up in pain and struggle through the day with pain, and when I go home and take off the patches, I am a prisoner of the pain; I cannot do anything socially after work, and since I live alone, I am frequently very lonely. Often the pain wakes me up at night, so I am frequently sleep-deprived during the day, which only exacerbates the pain and impedes my ability to be effective at my job.

For years I have sought other treatment for the pain. I have seen numerous physical therapists, sports medicine specialists, pain management specialists, acupuncturists, chiropractors, and orthopedic surgeons. I have even tried hypnotherapy. Nothing has helped. Because I am in such significant pain whenever I spend too much time standing or walking, exercise is very difficult; I cannot even use a stationary bicycle. I have tried to lose weight without exercise, both on my own and with the support of my primary care physician, but have not been able to.

This surgery is my only hope for regaining a normal, productive, balanced life. Please see attached a letter from my rheumatologist detailing how this procedure will help me in my current condition. I beg you to reconsider allowing me to have this surgery.

Writing to my elected officials may or may not have lit a fire under the NYS Education Department, but they finally granted me eligibility to take the LCSW exam. I'm looking into review courses.
Copyright (c) "Ayelet Survivor"

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