Rock and a Hard Place

[Ken (AKA-KP)]

I recently had a discogram that revealed small tears in L1/2 and L2/3. I have a herniated disc at L3/4, a fusion at L4/5 and a bulding disc with a tear at L5/S1. My options at this time is one - fuse L5/S1 (no sense having an ADR at this level when L4/5 is fused), shore up the fusion at L4/5 (two doctors feel this is necessary) and have an ADR at L3/4. The ADR will take on the stress/load so that L1/2 and L2/3 will not break down as fast if they were the weight bearing disc rather than the ADR. Now the task becomes trying to find a doctor that is covered by my HMO insurance to at least cover the fusions and pay out of pocket for the ADR here in Massachusetts is unlikely. Option two - go to Germany and pay out of pocket and have the best doing the job. Option three - is to fuse L3/4 and L5/S1 and wait for the obvious ... for L1/2 and L2/3 break down further and put me back to where I am now.
My doctor recommended Dr. Yue (Ct.) but he is not covered by my insurance. Is ADR an option for L1/2 and L2/3?

KP from Massachusetts

DDD
L4/5 fused
L3/4 herniated
L1/2 small tear
L2/3 small tear

[Juli]

How bout Dr. Bitan in NYC? He did my fusion and 2 level ADR. I am about 14 weeks out and feeling pretty good. Fortunately, my insurance pays 90 percent in network and 70 percent out. Out pretty much means anywhere and then I have Tricare as a secondary. But, neither covers ADR. I believe all my hospital expenses and other stuff is being fully covered by the two of them, just not the actual disc and surgeons fee for that.

Good luck.

[Ken (AKA-KP)]

Thanks Juli, I actually had a conversation with Dr. Bitan (what a great guy) but he doesn't deal with HMO's. Thanks for the thought.

KP from Massachusetts

[Judy]

I would first call and find out what your benefits are if you went out of the HMO. I finally was able to win my appeal with Cigna after one year of fighting. Dr. Bertagnoli did my surgery and they are paying (only because of the spinal fusion portion) 60% of reasonable and customary up to an out of pocket $5800 then 100% after. This decision was just decided last week so until I actually have the check in hand I have my fingers crossed. Again call your HMO to find out what exactly the benefits would be so there will be no surprises. I did this and luckily you know how they always say this call will be recorded, well these calls prior to and after surgery were infact logged in on how they did not tell me my surgery for the fusion would not be covered.
Best of luck to you and if you have any questions please feel free to contact me.

Judy

[mmglobal]

I've seen a few L1-2 procedures with Dr. Bertagnoli.

I question the idea that if L4-5 is fused, and you are going to do ADR at L3-4.... fusing L5-S1 is not an issue. There are concepts of spinal balance, load sharing and distribution, and just motion preservation in general. I know nothing of your case, the shape of your L5-S1, etc... maybe you need fusion there... but saying that fusing doesn't matter, for me, generates more questions than answers.

Mark