As I have stated in another post CIGNA PPO denied my 2 level. Today I went back to the original doctor that told me to look into ADR 1.5 years ago. I told him I was back to square one. He recently got trained by J&J for the Charite.

He told me some interesting things:
1. The ADR procedure really does not take that much more (in regards to resources) than a typical fusion. He said you still need a vascular doctor and the time it takes to do an ADR is not that much different. The problem is that each disc costs $11,000 here. The same disc in Europe costs $3000.00. So the insurance companies don't want to pay.

2. He was equally outraged about the denial and said that I should appeal it. He told me something interesting. His office insurance premium for his employees went up 20% (the insurance he offers to his nurses, etc). At the same time THE SAME insurance company cut his payment for services to his patience by 5% across the board. In other words they are both cutting compensation to doctors and increasing premiums for insurance.

It looks like there are two parties responsible for this problem. Not just the insurance companies but also J&J for charging $11K for the same disc that they charge $3K for in Europe.

It would be interesting to know if the denial rate would go down if the disc was the same price as it is in Europe.

Anyway, I thought I would share this as the insurance denial topic is a big one at this time.

Brad

Brad, the plot thickens! Can other folks who had ADR confirm this?! Perhaps the Euro-dollar conversion plays into this. So it's really $3007?!

Interesting find, thanks for update....

http://adrsupport.org/groupee_common...n_rolleyes.gif

I paid approximately $10,000 for my two prodisc in Europe.

Judy

There has to be a middle man in the USA resulting in the Disc Markup to $ 11,000 which from all of my conversations in January and Feb. was Manufacturers Suggested Retail Price. Anything retail big ticket from my experience (except jewelry which is 3x Mfg. cost or industry term 3 key) has (2) twenty five percent markups before retail level. To calculate a 25% markup multiple cost by 1.33 unless you have a markup calculator key. To figure cost at 25% markup, divide by 1.33. Please feel free to add extraneous costs like profit gouging to any of these figures. So take the $11,000 retail for one implant and divide by 1.33 twice and that equals $ 6,218 manufacturers cost of goods. Of course it could be worse (more profit) than this because I am sure Judy's' discs were not sold at cost. I am not the one defending insurance companies, you know that, but this is the same problem of overcharging I am sure they and Medicare are fighting over. In new product development it is called skimming and always has been and always will be the fact.

This week, Cedars Sinai in Los Angeles told me that the discs were almost $20,000 each when I offered to pay for them myself. I mentioned that I was previously told $11,000. They stood by their $20,000?????

Dale S

I was told by two doctors that the cost was $11K each.

Cedars is putting a profit on top of that for sure if they are charging $20K.
No wonder the insurance companies are not paying!

Brad

I don't know if this is directly applicable, but:

I found out when buying needed and much expensive antibiotics in Thailand that there is an international law for prescription drugs. The Denmark MD who suggested my RX in thailand that cost 5 usd and normally cost 200 usd in the usa said:

The law says that a pharmacuticle company CANNOT charge MORE for their pattened RX in in another country then they do in their own.

So, if the manufacturer is in yours, you pay the highest possible price so they can have adjustment pricing in the rest of the world....

Don't know if it applies for devices, i.e., charite

ko

HI just joined http://adrsupport.org/groupee_common...icon_smile.gif

FYI,

In Canada, the ADR cost is 4,000 $ CAD!!!

I think that US liability laws may also have something to do with it. In the States, J&J may be legally liable for manufacturing defects of their own and non-favorable surgical outcomes by association than in other countries. I don't pretend to be an international medical liability expert, but the USA seems to be a bit more litigious than other countries in general.

Best,
Laura

The hospital in NYC wanted me to pay 4,700 for each of my charite discs. They wanted this fee up front, I assumed this was the whole cost. Once I receive the whole bill I will let everyone know. This was just in September.