Hello from WA.
 

Hello everyone,
I've been using this forum to research for a few months now and following a few you as you journey toward successful treatment. It's encouraging to find folks committed to helping others thru such a difficult time.

At the moment my life is very overwhelming and challenging to figure out where to put my attention and research.

After my partner Yona filed an AWESOME 34 page appeal and two additional appeals with BCBS I feel that she knows more than me at this point about this disease. She will be on here with me and we will sign off with our names so you know who is on. We lost the appeal and now researching the options left.

At this point the options are to either pay for surgery ourselves or buy insurance in another state, like CA, where my family lives, to get either fusion or ADR.
I'd prefer ADR, but if it's not the best treatment I can live with that.

So, I just wanted to say hello, and best wishes to the few of you traveling/having surgery in the near future.

My initial questions are these:

Do you know if it's possible to get insurance in another state for the purpose of getting surgery?

How do I go about figuring out where/who to pay for surgery? that's a huge amount of research! I'm exhausted thinking about it.

Nice to meet you all,
Shay, & Yona too!

Shay & Yona, welcome to our community! When you can, please tell us a bit more about your spinal health, diagnosis, etc. See this topic for help:

http://www.adrsupport.org/forums/f58...-health-11053/

We are here for you, I hope we can help. : )

The question of which surgeon to use and how to pay is a huge task in itself. I'll put that one aside for now.

Private insurance, not group policies from your employer but the kind of policy you can buy on your own, almost always has preexisting condition clauses that would block seeking any payment from them in near term. You'd be more likely to get help by changing insurance carriers when you renew your benefits for the new year (assuming your employer offers coverage by two carriers).

Another potential way is for Yona to list you on whatever insurance she had if she can. Obviously that would only work if your domestic arrangements, that are none of my business, allow for it.

As for which surgeon to go see: first, you'll need to be honest about what you need and how bad you are currently. Multiple bone-on-bone levels with facet damage probably drives you to the best surgeon you can get to and afford. A single level's worth of damage from a single traumatic incident with no facet damage or adjacent level problems gives you more options. One piece of advice I'd suggest is to clearly think through what you need, then talk price after you have a clear picture of your needs. Don't allow cost to drive your assessment of your condition but then don't allow worries about outcome to cause you to outspend your bank account.

Thanks for advice...
 

thanks for the hello and the advice.
Unfortunately, WA insurance medical policy are all based on Milliman Guidelines so we are SOL. That's why I was considering out of state insurance.

Yona has begun inquiries with Drs. Clavel, Boeree, and Z, if nothing else their opinions. We are also continuing the good fight here in the states.

My doc agrees that waiting in in my best interest as I am showing signs of nerve damage that are not fun.

If we are reading the MRI correctly, then I don't think I have facet damage.
What did you all do for pain management?

Shay

very well put annapurna... i will add that you will want multiple opinions on:

1. what exactly your diagnosis is
2. whether you've exhausted non-surgical options
3. what surgery you should have if indicated.

these answers may all be the same, but often at least 1 will vary between surgeons/pain docs.

annapurna, LUD, good posts. Right to the point! I would only add my usual question: what is the cause of the degenerative condition?

Shay, thanks for adding your signature.

good questions all
 

I made an error earlier and meant to say my GP does NOT want me to wait very long for surgery due to other health issues.

The DDD runs in my family. I started showing signs in my 20's. I've been hard on it over the decades.

I'm confused by the diagnosis question. Are you saying this because diagnosing correctly is one of the biggest hurdles or for some other reason?

My very reputable surgeon has diagnosed my condition and I agree. However, it seems that a lot of people get multiple opinions, which we are in the process of also, both here and with surgeons overseas.

I feel very lost today. So much to do, learn and decide in hopefully a short amount of time. I'm thankful that I can learn from your experiences and that you all are willing to share them.
Shay

Diagnosing the condition of the disks is simple, facet condition is harder to figure out, and confirming the actual source(s) of pain and disability is extremely hard. As a quick example ,Dr. Zeegers once showed an MRI of a mystery patient with a bone on bone, dessicated disk and one above it with a mild bulge then proceeded to explain that the mild bulge was actually what was causing the patient the pain he/she noticed. Discograms and/or diagnostic injections are the general route even though they aren't pleasant. They aren't mandatory if it's obvious in your case but know that obvious isn't always.

Don't be surprised if you get a recommendation for a hybrid fusion at L5S1 and ADR at L4/5. You might want to read up on that as well so you know the pros and cons.

diagnostic procedures
 

Annapurna,
Yes, I'm finding out that diagnosis is challenging.
I've read about discography and considering that. Is a myelogram useful?
I looked at my MRI and concerned about the adjacent disc as a pain contributor.
What's the typical protocol? or is there even one?
Thanks again,
Yona

agree w/ annapurna - i would have a discogram before surgery so you know what the pain generator(s) is(are).

people here seem to have great results w/ hybrid if you have problems at L4/5 and L5/S1. a few have had 2 ADR's.... but there is really no data out there on how adjacent ADR's affect each other.

if it's just one or the other, usually ADR unless it's contra-indicated.