Does Kaiser Pay For ADRs?

[ans]

I was privately told this by a smart board member but it's hard for me to tell from searching online and of course, I can't find the Search function here.

Specifically, I wonder if the Kaiser's CA Risk Pool would cover this. I feel like I need insider's information on this. I guess the next question is who there is very competent. http://adrsupport.org/groupee_common/emoticons/icon_smile.gif

But one step at a time.

Thanks and be well. - ans

[LBP]

Well I thought Kaiser was listed on Charite's website for positive insurance coverage???

Also the search feature is the "FIND" tab.

The big question might be..who are the surgeons at Kaiser doing the surgery. I don't recall anyone naming a Kaiser surgeon doing ADR! How much experience do they have?

[Harrison]

Grasshopper, SEARCH and your will FIND. Or, FIND and you will SEARCH. http://adrsupport.org/groupee_common/emoticons/icon_razz.gif

This is from an old press release from Depuy:

CIGNA, which provides health insurance to about 47 million people, joins Aetna, Kaiser Permanente, Horizon Blue Cross Blue Shield and dozens of regional insurers, in covering the surgical implantation of the CHARITÉ Disc for low back pain and disability from degenerative disc disease.

July 25, 2007

http://www.depuyspine.com/about/about.press.072507.asp

[ans]

Duh, oh, the "Find" feature! Sorry!

Thank you both for your help.

My luck would have a one surgeon who I'd have to use who's done three ADRs. http://adrsupport.org/groupee_common/emoticons/icon_smile.gif

Wonder if they cover ProDisc. Maybe Dr. Bertanogli or Zeegers would use me as a patient where he'd demonstrate before other doctors. Yes, I'll count on that. http://adrsupport.org/groupee_common/emoticons/icon_smile.gif

[Jessica]

I have heard this from Kaiser Surgeons over the last few years.

In May 2006, I was told that Kaiser was "referring people to outside Dr's for Lumbar ADR, not for cervical yet".

In March 2007, I was told that Kaiser Oakland had just done their first cervical ADR in February 2007.

So, I would think they would have done several Lumbar ADRs by the time they got around to doing cervical. I don't know which device they are using or which of their surgeons has the most experience.

[ans]

Thank you Jessica.

I"m sorry that you are unable to work and I hope that your nerve impingement gets better.

I guess nobody knows if my facets are too far gone but this is an interesting option to pursue. Of course my luck would to have a guy do his second surgery and have a sneezing fit while he's placing the ADR. http://adrsupport.org/groupee_common/emoticons/icon_smile.gif

Best, ans

[brentmcd]

I'm in San Diego and have met with Dr. Daniel Green at Kaiser who does ADR surgery and actually had a Cherite and a ProDisc in his office to show me. I've talked with a few other spine surgeons since then, and they all seem to speak well of Dr. Green. I don't know how many procedures he has done though. Supposedly Kaiser will only approve a 1-level replacement, and unfortunately I've been told that I need a 2-level procedure.

[ans]

Brent: Maybe you could have a fusion at L5-S1 and an ADR at the other level - bearing in mind the risks at L4-L5. Sorry you're in this situation as I can see you were once an athlete. Thanks/be well. - ans

[graphicsliz]

Can you please tell me where Dr. Green is located? I've been looking and so far cannot find what office he works out of. I need to consult with Kaiser re: ADR/Fusion in next two months. Thank you very much, liz

[racheleddie]

Dr Greene is at the Zion hospital medical offices. I am currently seeing Dr. Flippin in that office and happened to notice that Dr. Greene is in the same office. I've heard many, many good things about Dr. Flippin as well, so you may want to consider him as a Kaiser spinal dr as well. I will be having ADR surgery sometime in thenext 4-5 months, as that is how long it takes to get a surgery appt, although I am fighting hard and being the squeky wheel so hopefully yhey will move my surgery date up sooner! Best of luck to you! Let me know if you need the number...I can look it up for you.

[Deborah]

For those who feel strongly 2 level TDR is what they need... remember FDA approval shouldn't be far off if you can wait (within one year). I agree totally with ans about considering hybrid; many doctors and some of us individuals actually find it preferable for L4-5 TDR and L5-S1 fusion. (It turned out in my husband's case that L4-5 could have a well seated and placed TDR, but the L5-S1 level skews just enough, which apparently isn't unusual, that a TDR wouldn't be perfectly aligned... not fully visible until exposed by surgery.) There's the consideration that for most people L5-S1 has very little movement naturally.

ans: You know you can make this happen. Get a few doctor consults from docs you trust and go for it... there's a lot of data out there now that makes hybrid a much more winnable fight. (I'll be glad to share the particular studies used to convince CMS, but I'd guess most docs can get a pre approval in their own way.) The biggest issue if docs consulted find you an 'appropriate candidate' given your specific back condition. For that, I'd see at least 2 docs you really have reason to trust.

Debi

[ans]

Thank you very much Debi. My best to hubby. - Allan

[JaclynR]

Hello I am a patient of Kaiser also and just had a one level ADR L5/S1 PRODISC. I have my surgery in Baldwin Park at the spine center so I dont know if every county covers them or not. My surgeon was Dr. Tang, Chris. I also know they use different disc's for the replacements I just dont know all of them. I do know that the charite one was recalled by kaiser and they will no longer implant them for whatever reason they have. I also know that kaiser now has a lot of different coverage plans and depending on the plan patients have will determine hosptial co-pays, deductibles ect. So although kaiser does implant cervical and lumbar ADR at least in LA/Orange county Iam not 100% they cover everyone or every county or state. I hope this helps!

[ans]

Thank you J. Best of luck to you. - Allan

[JaclynR]

Thank you ANS. I had a great experiance with kaiser, If anyone has any questions, Iam more than happy to answer them.. :)

[Adrienne]

I don't know where you are but I do know that Kaiser Oakland does them. They would have done mine but for my slightly arthritic facet joints and suggested a fusion instead which I ended up doing at Stanford.
The surgeon seemed very knowledgeable and spent an over an hour with us. I'm blocking on the the surgeon's name but it started with a G. Gorek?

[ans]

Dear Kaiser Members,

J: I'm amazed that they approved a ProDisc at this level. I hope that you are faring well.

Duh, was your surgeon well-trained in ADRs or different fusion techniques?

Does a member have a choice of surgeons at all? I'm a bit leery b/c I've been told that there's little choice w/Kaiser.

Appreciate your time. Best - Allan