Diagnosis: back pain.
Treatment: spinal cord stimulator.
The insurer denied a spinal cord stimulator.
The health plan's determination is overturned.

This is a female with a long-standing history of back and leg pain. Her pain is severe and limits her ability to function. She had tried and failed conservative treatments including a lumbar epidural injection. She was evaluated by a neurosurgeon who recommended spinal cord stimulation.

A Spinal Cord stimulator is medically for this patient.
This patient has severe back and leg pain with functional limitations from lumbar degenerative disc disease (DDD) and radiculitis. Further treatments are medically necessary to improve her pain and function. Her neurosurgical evaluation indicated she is not an appropriate surgical candidate and spinal cord stimulation is the next step intervention. Current clinical studies support spinal cord stimulation is an effective intervention for back and leg pain. Given this clinical scenario, spinal cord stimulation is medically necessary.