I am providing the following information in the hope of helping others who suffer from SI Joint Dysfunction and have been denied by their health insurance providers.
First, I am very thankful to the outside review agency that overturned HealthPartners decision to deny me the SI Joint Fusion surgery and additionally to my surgeon, Dr. David Polly, at the University of Minnesota Physicians. I am also thankful to Dr. Kristen Zeller-Hack and Dr. Amy Stromwall who took the time to be sure that it was my SI Joint that was injured and then referred me to Dr. Polly. My recovery and function have improved to nearly normal levels. Before surgery my Oswestry disability index (ODI) score was 67%, which indicated severe disability. At 6 months after surgery my ODI score is 6%.
I am a wife and mother of 4 boys. My injury to my SI Joint occurred October 2009 (Age 39) by bending forward to grab a table to move. I felt and heard a snap in my left low back/buttocks area. By that evening I was in severe pain, could not walk and had to be taken to the Emergency Room. From that time forward, I struggled with bilateral instability. I had tried ice, medications for pain, manual manipulations, Physical Therapy, Aqua Therapy, SI belt, home therapy program, numbing block of SI Joint twice to prove my SI Joint was causing the pain, and cortisone injections.
After 1 1/2 years of trying to stabilize my pelvis and SI Joint with the help of my Doctor, Pain Doctor and Physical Therapists, all of whom specialized in SI Joint Dysfunction, my doctors referred me to Dr. David Polly for a SI Joint Fusion surgery. My doctor did warn me that I would have a fight on my hands to get the insurance company to pay for the surgery and suggested that I collect all my medical records, which I did, and bring them to Dr. Polly when I met him. Dr. Polly concurred that I would have a fight on my hands especially since HealthPartner’s had never paid for one SI Joint Fusion surgery. After Dr. Polly’s examination, he felt I was a good candidate for the SI Joint Fusion.
As I suspected, HealthPartner’s denied my request to pay for my surgery, even with all my medical records, letters from doctor’s explaining my situation and need for this surgery, and my own testimony of my limitations. HealthPartner’s position on denying the SI Joint Fusion surgery was that there were no peer reviews, no clinical studies, and that this surgery was Experimental and Investigational. Although this surgery is not routinely performed it has been around for 50 years. Although this procedure is not common, I found clinical studies, one from Johns Hopkins which showed the benefit to 20 patients, of whom I had very similar symptoms. I also found peer reviews and FDA approval of the implant for the surgery. All of these things I forwarded to HealthPartner’s to disprove their claims as I appealed their decision to deny my surgery. They denied me again even with all the information I found. I appealed again and was denied again. I appealed as many times as I could before they said I couldn’t appeal again and then I contacted the State of Minnesota for one final attempt at appeal.
Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region. This pain is caused by abnormal motion in the sacroiliac joint. The abnormal motion typically results in inflammation of the SI joint, and can be debilitating.