Successful Appeal on Multi-Level ADR
Colorado Babe - I am very happy that you won your appeal for ADR surgery. I am also a bit surprised that you were successful if you are obtaining multi-level surgery for the cervical & lumbar areas. My questions are:
Which insurance carrier do you have?
On what basis did they deny your request, e.g. experimental, inadequate conservative treatment, etc?
What additional information/documentation did you provide on your multiple appeals?
How many levels of ADR were approved?
Which levels were approved?
This info can be helpful to countless others. I wish you success with the surgery and your recovery.
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1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.
New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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