Many thanks to all on ADR support
 

Hello all. Its been too long since I have yet to post on this forum. I am in debt to all that have shared their stories which has helped me make an informed decision!

Back on June 5,2013 after much reading and cancelled double fusion, cancelled implant surgery (to remain unnamed) I found through all of you here the right man for me. A wonderful,humble,gracious, etc etc etc. I could go on and on Surgeon from Spain that implanted M6 C's in C5-7.

I met Sonja B while in Spain and wish her continued success since she was in bad shape for a while there. She truly is a trooper!

My surgery went very well. I was up an 1.5 hrs after i got back to my room. I went outside with all the stuff hanging off me and ate (forced down) a sandwich and sucked up four or five espressos with my brother. We walked at least fifty miles while in Spain which kept my mind off of it.

Now I know not everyone is the same and I have a very high tolerance to pain but what I can say is if you are worried about getting fixed DON'T WORRY. Yes it hurts some but what you have been putting up comparative to the surgery is nothing. Yes I too was worried but no more and may need to get two level lumbar done coming soon.

I was pain free from the day it was done other than minor aches and some facet banging.

To Dr. C I cannot thank you enough for giving my life back to me.
To those contemplating you are strong enough to get through this! Believe it and you shall see it.

Good health to all. anyone can feel free to PM me for anything and i will be happy to share.

Frank :shedance:

facets
 

Well yesterday was your half-year anniversary then!:clap: Glad to hear from you and thankful for the information you have shared.

You mentioned your facets--can you please be a little more specific about that? How was the degeneration rated? Can you describe your facet pain or could you tell the difference? Have you had an facet injections post surgery?

Wow, 50 miles! That is truly remarkable. So glad you got to enjoy Spain as well.

Take care and keep us posted when you get the time!

Hi Jen,

Didn't even realize it was 6 months. For me i was back in work running my company the following day i got off the plane here in PA.

No facet Degeneration or shots. I'm an average height person but pretty muscular or was haha. Back now. At any rate I think if you push too hard prior to being ready then the new flexability enables them to band each other and will cause some pain that lasts.

I think the key for me was that i went in to this in pretty good shape. I was not in an active flare up and was working out hard so could come out faster. I think most people want to believe that this will go away when they feel better and put the decision off including me for many years. i refused this time!

Now its time to fight the insurance company

Frank,

Congratulations on the successful surgery! And here's to a continuing excellent recovery and outcome. I'm glad you were able to enjoy Spain. Wishing you the best with your insurance company. I hope you have better luck than I did.

And ... thanks for the reminder that many people in pain that will never post do troll this forum for help and otherwise useful information.

Good luck, Jeff

Jeff,

You are right about some that never post but mostly I would like to believe aren't trolls. I think they get fixed and move on. I found myself wanting to post many times and just get too involved in doing work and never get back to it.

I see many of your posts and am grateful for all of your insights.

One back at you here I found interesting in looking up info on Epidurals. I am finding that these injections ARE NOT FDA approved? Is that so? Is this your understanding also?

This would be a very interesting thing if true to use as ammunition. Lets see one of the steps in getting fixed as far as a stepped approach is to have these injections done routinely as par for the course and the Insurance companies pay out all the time for this. Why then would they dismiss a device that is not FDA approved?

Just food for thought.

Frank

Frank,

I didn't intend the verb "troll" to convey any pejorative; just that there are many look for information here that don't post. Summoning the powers of Google just now I do see that the word "troll" used relative to internet forums is pejorative. Hereafter I will use the verb "surf".

I don't know anything about ESI's being FDA approved or not...

Jeff

Jeff,

I did in no way mean you meant it as stated and I know really what you meant for sure. Yes it is negative in context and can be taken wrong.

No worries. Lets all just continue to do well and wish others the same as you always do.

Good health and continued progress! I need to get two lumbar done and am not looking forward to the bill nor the trip but cannot continue in this kind of agony much longer.

Interesting on the EPI's though is it not?

Frank

Frank,

The "FDA approved" title seems somewhat ambiguous. Example: the M6 is not FDA approved and absolutely, positively cannot be implanted on US soil. Multilevel ADR is not FDA approved, but has been done in the US for many years. Now that the Mobi-C has received FDA multilevel approval, does that mean that all ADRs are FDA approved for multilevel application? Even though they've been done in the US for years? Further, insurance companies don't cover things that are not FDA approved. But until recently they didn't cover ADRs that were FDA approved. So I'm not exactly sure what "FDA approved" means. That ESI's are not approved, but are covered is interesting and confusing.

As far as using that as a tool in getting BCBS to pay, I wish you the very best of luck. The people that I dealt with at BCBS were more slippery than a live catfish. The poster that goes by the name 2Confused was successful in getting BCBS to pay for her single level ADR with Dr Clavel. Here is a link to her post.

Any time frame on the lumbar?

Good luck, Jeff

Im with you on that. Do this because we say but don't do that because we won't pay. we won't pay if it is or will pay if is not or vise versa. Crappy part for me is that i spend about 80-90K in premiums for my employees and insulting as it is I have to pay out of pocket for the correct implant (my opinion) out of pocket.

Everyone will wonder what the heck happened when the supposed ACA kicks in full blast. Bad enough now but going to get worse unfortunately. Sorry for the rant.

Lumbar was actually gonna try and fly out yesterday but couldn't get flights. Flights out for 19th or 23rd surgery are insanely costly at 12k+ and thats not even first class. I need to wait to see what the airfares look like after the holidays or reach out to those that may know when they come down in price. seems a waste to spend half the cost of the surgery on flights.

My only quandary is that if I can hold on that long and not go for a micro lamidisco now. My surgeon here can get me in this week if i wanted.
Im not sure of the ramifications of doing so but i wouldn't think it would be preferred and risk scar tissue on posterior then implant after. common sense says to me that it most likely would be counterproductive regardless of a stepped approach.

Frank

Hi all,

Just a quick note to say that that I had 2level ADR Surgeryand BCBS did pay approx 60%. Frankly, I do not understand why they paid for my surgery when so many others are denied.

Frank, best of luck to you and as I stated in P. M. I will email you tonight.

2Confused....you did say before that you have a WorldWideBlue coverage plan correct? Do you know if this a paid-portion of your coverage, or should most people who have BCBS contact them first before approaching procedure?

Do you know if you PAY for WWBlue or not?

Plus, did you get pre-authorization, or appeal a reinbursement?


Your case could prove invaluable for those seeking coverage thru BCBS. If you have time, i would suggest posting how you went about the process.

I've read that Dr. Clavel is U.S. board certified, this could also play a role in the quest for reminbursement.

Frank,

I know you did great today. Wishing you a restful night's sleep tonight.

Good luck, Jeff

Jeff,

So Sorry for not posting sooner. Yes i am doing fantastic!!!! Surgery went off on 12/18 at 745pm. Climbed on the table myself which was cool.

It was a double edged sword though. I had been working very hard with a private trainer from 1st week of september at the Gym gaining muscle mass back. i had lost alot during the cervical issue and subsequent double M6. i normally walk around at 205 fighting weight. in 14 weeks i put on 18 lbs of muscle and dropped 7% body fat. so im walking around at 225 now.

They really had to beat me up bad to get in there from what Clavel had described and warned me prior in my initial meeting. Great placement on the ADR's. Oh and I'm a freak apparently i have an extra disc S1S2

Waking up up was horrible do to stretching the stomach muscles so drastically. Didnt get out of surgery/recovery 11:30pm. Just the schedule of the day. I was standing the next morning at 8am and walked a short bit, got up and down in a chair. Somewhat painful! Walked around for 20 minutes 3 hours later. Any advice I can give is go in the best you can muster and the reward is tenfold.

today is 10 days out. I have walked about 20 miles total with many breaks. Pain/symptom free but for surgical stuff. Walk walk walk. Have full 90plus degree stretch already on the hammies from the Physio. So im very happy thus far.
Thank you for staying in touch. Ill share more when i get home. Long flight tomorrow. Clavel mentioned a big conference in the UA i believe Spring time with all or a lot of the players. Things have really improved for the better here and not that it was ever bad. Always nice to see people refine there business along with keeping the non rushed, caring, fantastic bedside manner and and just all around great guy. more to follow!
Happy Holidays to all and wishing all the courage, means and emotional strength to get fixed.
All the best,
Frank *** i know wrong location for outcomes*** feel free to move

Bwink,

Dr. Clavel Father was is US board certified. I asked him last week. Doesnt matter. He IMHO is an awesome guy as evidenced by going back for double lumbar 6 months after double cervical.

Insurance is BS since they will find any way in most cases to not pay. Fight facts with facts and they will bend. depends on how much energy you want to spend instead of healing.

Frank,

Twenty miles the first week after lumbar ADR?! That's extraordinary! I can think of only three other lumbar patients on this site that have managed something like that. I'm not going to burn the energy it would take to tell you take it easy. Good luck on the loooong flight home.

Jeff

Brink,

Yes, I have Worldwide Blue with my BCBS Policy. To be honest I did not know this until I started researching and reading my policy prior to making the decision to go to Spain for surgery. My suggestion would be research your policy to determine if you have WWB. I must assume that it would depend on the type policy one has as to whether WWB is included in their coverage.
I did not seek pre-authorization, nor did I go through the appeal process.
Upon my return from Spain I gathered all the documentation to be sent for my claim and sent it by certified mail to WWB. About 6-8 weeks later we received a letter from BCBS saying my claim was being reviewed. ( we fully expected a denial to arrive soon after) however, A couple of weeks later we received a check in the mail.
I really cannot explain why BCBS paid for my procedure but denies other claims.
I might add I had documentation for over three years of doctor visits, treatments, physical theraphy, a letter of medical necessity from both my NeuroSugeon and Dr. Clavel. All of this was included in the package sent to WWB, with a cover letter CC'd to my attorney.
We also included the following in the cover letter "the procedure performed is not experimental in the country where surgery was performed".
Hope this helps.

Frankly,
Glad to hear you are recovering nicely!! Walking 20 miles? Wow!! Impressive.:clap: