Things are looking up

[jchebert1979]

Well I found a surgeon who has done many ADR's and participated in the clinical trials just an hour from my house. I was able to set up an urgent appt. for Friday because someone canceled while I was on the phone trying to set an appt. Not only has this surgeon performed more than the other (who was 3.5 hours away), he can get me in as soon as May 21st.

The only problem is that the nurse says that BCBS will not approve the Prodisc-C. She might be basing this because we are in Louisiana however I have BCBS of Texas. I have already looked up the criteria for approval and I meet it.

Just so there is less chance for a hold up, I have basically prepared a full denial appeal (as per Laurie Todd's book) and worded it as a "pre-approval request". It is about 80 pages long, structured, and bound. Hopefully this will let them know that I am prepared to fight even before the fight begins.

I will definately let the board know the outcome.

[jchebert1979]

I just got back from the appt. For the first time in 19 months I actually have some validation. This doctor said that the annular tear that I have causes pain in 99% of people who have it and is probably causing a large part of my symptoms.

He also said that even though it is controversial, people with annular tears can have a great deal of pain with no nerve compression due to chemical radiculitis. This is where the chemicals in the disc leak out and inflame the surrounding nerves.

The last part of the process is the insurance but I think I have that covered.

[symara]

if you don't mind me asking, where are you located and who is your insurance with?

I'm glad you have some answers.

[symara]

nevermind, saw your other post

[Harrison]

This annular tear business is tricky for sure! We've had several patients each year that has doggedly pursued this specific problem -- Poncho comes to mind.

J, what's the next step? And as far you can tell, does this "match up" with your pain dermatome?

[jchebert1979]

Harrison, despite the few symptoms that don't seem to add up, the exhaustive workup I have had leaves only this. I am 100% sure that it is causing pain, whether or not it is causing all of my problems, I guess we will see after surgery. I can only hope.

I just can't see how this was overlooked for so long. Every MRI report (total of 4) says that I have an annular tear, I just don't understand that with all of the Dr's I have seen only this one even suggested it could be causing problems.

I forgot to add in that post that we are going forward with the Prodisc-C. The doctor will e-submit the pre-approval and I sent my big packet overnight to the operator from BCBS that has been helping me. I have all of their criteria and I have talked to my benefits director. She said that if they do deny it unjustly, she can overturn it.