Any hard evidence I can show insurance that Prestige better than fusion?

[bsnbabe]

Hello friends: Is there any hard core evidence that I can show my insurance company that proves that the prestige cervical disc outcomes are better than a regular fusion? They denied my ADR on the basis that there isn't enough evidence beyond just "theory" that proves that an ADR is better than fusion. Thank you! (I am in the USA) Or, is there a proven better artificial disc besides the Prestige?
Lee

[Sandra L]

have experience with ProDisc-C having had 4 discs replaced last April. ProDisc-C was approved by the FDA for one level in December 2007. I went to Germany and am trying to get Anthem BC BS to cover it, but don't think I will be successful.

If you want to check out this prosthesis you can visit Synthes Spine at http://us.synthesprodisc.com/EN-US/SurgeonInformation/ProDiscCervical/ (http://us.synthesprodisc.com/EN-US/SurgeonInformation/ProDiscCervical/)
read both the patient and surgeon sections. You can call them at the ProDisc hotline (1-800-895-7764) Monday – Friday, 9 am - 8 pm (EST) and they will give you a list of the doctors who have completed the training. Then you have to make calls to see if anyone is actually doing the surgery. They also have a section to help you get insurance coverage.

Terry has had success with Prestige, he's on vacation, but sure he will get back to you. There are other cervical Prestige ADR's here, search Prestige and ProDisc-C. There is another cervical device Mobi-C, but don't think it's approved here. Available in Germany however.

Let me know if I can answer any questions. I'm a patient, but there are many people who have been in medical field for years, plus having ADR surgery, who can give you many different options. Good luck and take your time researching a device and a doctor. Sandy

Lee, There are some people who have gotten coverage and other's none. It seems to help if your surgeon has connections and is will take the time to help you with this. There are even surgeons in your area who have gotten permission from the FDA to do multiple ProDisc-C. Search Dr. Delamarter in Santa Monica/LosAngeles or Dr. Chapman in Seattle to see if there is a patient who has gotten insurance coverage.
Sandy

[annapurna]

I can't remember if the Prestige has CE mark approval (Europe's equivalent to USA FDA's blessing) but if it has you should be able to dig out the report they submitted for their approval to show that the disk does work.

The answer to your second question is that there isn't a disk that has been proven to be substantially better than the others in a clinical trial or through an extensive use history. All we have is speculation, analysis based on speculation, and lots of marketing.

[Leora]

Hey there. I am currently getting an insurance appeal ready ahead of time (looks like I will be having prodisc with delamarter since the cost difference isn't AS much as I thought. I'd love to go to Bertagnoli but the travel will kill me). Anyway, Synthes, the manufacturer of the ProDisc, can give you literature/studies showing superiority of ProDisc to fusion. It's different for cervical than for lumbar obviously, or I would just share all the studies/citations I have accumulated. But look on their site and then call their "PAL" Patient Assistance Line...(too cute by half, I know. :) That's what they call it). Wishing you much luck.
Leora

[Sandra L]

Leora,

If I were as close to Delamarter as you are I wouldn't consider going out of the country. You'll be fine.

I'm not having any luck with insurance. Dr. B's charges are a flat rate, BC/BS wants an itemized, day by day, hour by hour!!, charge for each individual thing, like they do here. You know $100 for a pain med, etc., etc., :flaming:

Best wishes, will keep you in my thoughts and prayers. Sandy