Only approval for one Disc! What to do?
 

I have recieved approval for one disc to be replaced. Do I wait for FDA? Should I get one done and get the other when FDA does approve? What is the cost for the Disc? In theory the hospital stay is paid for by insurance. I should only have to pay for the disc.



Hermiated discs L4/L5 & L5/S1 Aug. 2007
Reoccurrence in L4/L5 Oct 2007
DDD Dec. 2008
Dec 2008-Positive Discogram (L4/L5 & L5/S1 annular tears)
Dr. Yue at Yale Hospital, CT
Diagnosis - Need bi-level ProDisc ADR. Worker Comp Ins will only pay for one level.

cttom, personally, I wouldn't wait for FDA approval for a second level. That could be till the cows come home. You're fortunate that you got one level approved. Many on this board never got any levels approved after exhausting all appeals. I couldn't tell you what one disc costs. Ask your surgeon. He should have an idea. My 3 discs installed, including all costs, was roughly $62,000 in Germany, by Dr. Bertagnoli. Good luck!

spoke to the Dr. office
 

Here is the costs. $11,000.00 for the disc but approx. $25,000.00 for the additional services for the second disc. $36k if I wanted to pay for the second disc.

Am I understanding this correct? Your insurance would pay $25,000 for you to have 2 levels done, and you would pay out of pocket roughly $11,000? Who is doing your surgery cttom?

Basically the way i understand it is, they will pay for one level. Approx 40K. The other level would cost around 36k. 11k for the disc and another 25k for hospital stuff. I was hoping the surgeons charge would be less due the fact they are already performing a surgery. They explained it was for added time for all personnel.

Negotiate, negotiate & negotiate...
 

Times are tough and nothing is cast in stone. I say negotiate. Maybe arrange a meeting with the hospital administrator and say look I'll pay the $11,000 but the additional $25,000 is just too much. It only makes sense to do two levels, so I'll either have to go overseas and have the two levels done there, where the disc costs less and the labor too or have two levels in the states on a cost competitive basis. I would offer $23,000 for the patient out of pocket part or tell them I am going elsewhere. It's free to ask.

If you can't stomach $23k, then offer what you can afford.

It just does not make sense that the second disc will have labor costs of $25,000 because it is only taking about another 20 minutes.

Have you and/or your surgeon considered a hybrid surgery? There seems to be some discussion on whether it's preferable to do a TDR at L5/S1 or fusion (due to lack of normal motion in that segment). You might want to discuss the advisability of this with your surgeon.

Debi

Hello Tom!
 

Tom,
I will let you know what Dr. Yue tells me about his thoughts on the hybrid as Debi suggested at our levels after I see him on April 1st. I'm sorry you weren't able to push through the medical insurance nightmare and get what you wanted.

I'll reply on the boards so others can see too ...

JJames, I want to thank you for offering to post what Dr. Yue says about hybrid surgeries. I have heard both arguments, on fusion or TDR at L5/S1.

Good luck with your appointment tomorrow.

Wish I had some news ...
 

Hello Cathy,
Unfortunately I came up empty at my appointment with Dr. Yue. I never even got a chance to ask any questions about surgical option. He has ordered another MRI, which makes sense as it's been quite awhile since I had my last one, I've been in a car accident since then, and my pain levels have doubled what they were previously.

Comically, he also gave me an Rx for more PT! I wonder how many times you have to have PT before it fixes discs with annular tears. Perhaps it is the eleventh attempt! If that's the case I should be cured in the near future!

Sorry, had to vent a little. Once my MRI has been done and I see Dr. Yue again, I still plan to discuss the Hybrid and any other options with him. It could be a couple weeks (at least), but I will post whatever information I am given.