Lost the battle with uhc

[gclc1457]

After several months and 4 denials from uhc for adr surgery, i have decided to move forward and scheduled fusion surgery. My surgeon will be performing an anterior lumbar interbody fusion at l4-l5 on april 21, 2009. I really wanted to have adr surgery vs. A fusion, but after 8 months of trying, and what i thought were some darn good appeals i was not able to get uhc to overturn there decision. It was a big let down, but my wife and i are confident that this was ment to be. So we are letting it go and moving forward with an optimistic look at things. If anyone has had this procedure performed and could tell me anything about it i would greatly appreciate it. All i can say is if you are fighting your insurance company to get approval for adr surgery, keep fighting. Dont give up. Although i have quit the fight , i feel i gave it my best shot, and have no regrets . Personal issues have forced me to stop fighting uhc, and now it's time to take care of myself. But, i wish everyone out there the best of luck in there own battles with there insurance company.

[Deborah]

Did you have the physician at the front of the fight for you? I really think that's the needed key... a doc (with access to all the data, studies, and with the credibility to prove the point) willing to fight the good fight!

Now that you've made the decision to go for it with fusion... I think you're right not to consider it a total loss. The reality is that most trial results show fusion has very similar long term outcomes to TDR. We don't really know absolutely for sure that TDR will prevent other levels from being involved... it seems logical, but we just don't know until we're getting in solid long term data (which isn't even being reliably gathered for the most part). Someone with 'some' damage on an adjoining level may find it takes longer, but still happens... I don't know.

Trials do show that recovery is quicker with TDR ... there aren't as many restrictions for as long, since there isn't the same need for major bone knitting to take place. It may simply 'hurt more' after a fusion, but that's not a certainty. What matters is your recovery, and results come in only a bit better with TDR. We all want that bit of help, but you can make a fusion change your life for the better, too!

There's no question in my mind, particularly after a very definitive discogram (have you had one??) getting the 'bad discs' out was the most critically important factor to my hub's surgery.

Blessings!
Debi

[JJames]

gclc1457,
I am sorry that you and I are both stuck in the same situation of losing the battle against the overly powerful and well funded insurance companies. Isn't is ironic that they are so well funded due to all the money they take from our pay checks each week!

If you're up to it post-op, please let me know how things go with the fusion. I have an appointment with my surgeon in two days and will be asking for the surgical codes for the hybrid and for a bi-level fusion to present to my insurance company to see what exactly they are willing to actually cover!

Good luck to you, and quite literally, I believe I feel your pain!