I have been stuck at home and unable to work since Jan 3rd because of my bad back I got from my car accident. As I approach June, I realize that I am still sane but getting really aggravated with my situtation. I do a lot of pacing in my apartment and have no clue what to do. I do get out a little bit each day, but it isnt like spending a day working. I never missed working as much as I do now.

I was thinking that, my insurance company wont pay for my surgery but I have another insurance company paying me to stay home since I can't work. In essence my health insurance is shafting my disability insurance because they have to keep paying me since I cant get better and go bakc to work. In a month a start my long term disability thank god, I will get more money in my pocket.

If I was able to work, I would def be in a better situtation as I would be able to wait to have the ADR surgery. I can't wait anymore, and if I go to war it will take a longer time, so I think I am gonna try to pay for it myself and then sue the insruance company for the money.

Hi,
I'm not in your situation but in a situation of my own waiting for the day I can have surgery. I just wanted to say that I hope you can get everything worked out soon as it doesn't sound like you can wait much longer. Someone will come along and post who has has already surgery and was able to get reimbursed for the costs.

My surgery day has passed 2 times already.

I am not in your actual situation but I do know what it is like to be stuck at home not able to work etc.... you feel like you are in limbo.

I hope you can get the surgery you need soon and start to get back to normal!!!

Take care!

Hi Jason,

I have been on disability since my accident in Oct. I still wake up at the same time I would if I was going to work 5:30 am. I try to go back to sleep but my mind what to get going. I have been ready to quite my job for years but now I miss it more than anything. Not getting to see the kids is the hardest part of this, I teach PE to children with disabilities. Will they remember me?

One of the things I have been told is to get up, get dressed and start your day like you are going to work even though you may just go back to bed. This is a way for your body and mind to get refreshed. Be on some type of schedule or program. For me having appointments, PT, therapy, doctors is also a good way to get me out of the house and not feel so shut in. My dog Lilly also helps me a bunch.

This may be more difficult for you and are only suggestions that have helped me. I feel for you in regards to the insurance issue you have the right to be flaming mad! http://adrsupport.org/groupee_common...s/icon_mad.gif Don't let them mess with your spirit and drive for the truth. Keep plugging along. This is your job now even though you didn�t apply for it.

Hang in there and have faith buddy it will all workout and in the end you will be so much better off then you are now and will have paved the road for others to follow in your foot steps. It�s hard to be a pioneer and you are in the mist of digging trenches that will produce an abundant crop in the future.

Let me know if I can do anything to help as I have lots of time on my hands as well. I always love a good fight! http://adrsupport.org/groupee_common.../icon_wink.gif

Paulette

Jason,

The sad truth is, your insurance would probably pay for you to have surgery right now -- fusion. That is to say, you could get your problem fixed, in an archaic fashion, go back to work, then be right back where you are now when your L3/L4 disintegrates in a few years. Hey, then they can fuse that, too! Lock you up tent pole. By the time you're 50, you won't have those worries about work, or being able to move, and it will be totally irreversible, so you won't have to worry about getting anything fixed, because it will be impossible.

How can this be? As we all know, ADR is FDA approved, (one level). Stan was right, there needs to be a federal statute that bars insurance companies from tagging FDA approved procedures as "experimental". Trouble is, Big Insurance owns the rulemakers. But there is a way.

Your first idea, the part about contacting the media, is it. Only massive public outcry has even a chance of changing the system. As spoken so eloquently in the movie Young Frankenstein, "A riot iss an ugly ting. And I tink it's about time ve had von!"

I too will help in any way possible. We need to expose this for the crime that it is. Maybe everyone that is in this Appeal/Denial Vortex could get together and simultaneously call multiple major media outlets with their story? I'd be happy to contibute to the talking points, since I'm in the process of putting all the arguments to paper anyway for a (pointless) second level appeal. Anyone with thoughts on this?

Cheers,

Dave

I am working on getting a lawyer who fights the insurance companies. They are keeping me out of work because of this.

I thoguht about fusion but my l4-l5 has a tear in it so fusion isn't the answer.

Jason, as you know, I paid for my ADR myself and HAD BCBS. My letter of appeal is posted in this forum.

Happy to help in any way that I can...

I also paid for European ADR on my own and appealed after the operation. I think it was easier for them to deal with documentation of actual costs. It was obviously 3x cheaper than a fusion which was surgery indicated by all of the US doctors. I included all of their reports as part of my appeal. The PPO reimbursed about 90%.

Jim

hi guys and gals.i am getting a fusion tomorrow and i dont think all fusions are bad...i think i have the best back Dr in boston and he said this will have the smae outcome as a adr..maybe it depends on the disc and which one it is..i do trust my dr...i am haveing L5-S1 done...if the disc on top of that goes bad ,,thats the chance i take..peter