3 appeals denied by United Healthcare last year and initially this year for 2-level Prodisc not b/c multilevel but b/c UHC claims experimental/unproven treatment for DDD. I paid out of pocket with Dr. Delamarter; UHC denied coverage on the date of my surgery. B/c self-funded plan through my employer I was not able to appeal to the CA Insurance Commission or the CA Dept. of Managed Healthcare. I am still in appeals process for reimbursement but do not expect that will happen. Not workers' comp.

I'm in Minneapolis, with HealthPartners, self-funded plan thru spouse's employer. Denied 3 appeals for 3 level lumbar ADR. Paid out of pocket to go to Germany for Dr. B. Not worker's comp.

I am in Illinois.
cigna ppo is my primary carrier.
2 appeals denied.
bc/bs il is secondary carrier.
2 appeals denied.
ADR Charite device at l3-l4, "hybrid" application combined with 2 level fusion below at l4-l5-S1.

Was denied as considered experimental technology. Also because it is outside the FDA approval criteria as being used at l3.
FDA approval for charite is for single level from l4 to s1 and thus my surgery did not meet specifics.
I am not a work comp case.
4 level fusion still pending approval they are also fighting on that one!


ck

denied and used all appeals with blue crap of penna.
IBX blue crap. Self paid to go have dr. b preform a single level at l5-l6.
after returning home submitted again to blue crap as out of network and was told i was to receive payment then they turned around again and denied the entire thing.
so i have given up as far as suing them as you cant get any thing back accept the cost of the surgery. no lawyer fees no travel fee etc... GRRRR
ok enough of that now just writing about it again has in raged me once again.
chuck

i am a 43 yr old male. denied L5/S1 disc replacement by unicare insurance. no worker's comp -- only personal health ins policy. i am optimistic to be chosen for active-l disc study beginning in dec.

Denied, Denied, Denied...UHC, PPO two level L4-S1 ADR and/or hybrid. Final decision came from the company's Director of Human Resource. Not a WC.

I agree with Chasswen, just typing this puts me in a BAD MOOD.

I live in Southern California. I was first injured in a student fight, at the high school where I was a teacher. I suffered a second injury lifting a heavy box over another one, also at work. No surgeon on the list Workers' Comp gave me does cervical ADR, so in effect, I have been denied. Dr. Regan (not on my list, I paid to see him and another surgeon out of pocket) recommended a two-level ADR.

Hi all,

Been denied,denied, denied by Blue Crap of Nebraska for a single level Charite.

Had to go fusion route on L4-L5. I am just about three weeks out and I remember that I felt better when I had ADR surgery.

Sue S

Sue,

I find your post a little alarming. Hope you can expand on your "signature" a bit.

What jumps out at me is that you're having a fusion at an adjacent disc level just 2 YEARS post ADR????

Since you had Kineflex..I am thinking it's likely you were a participant in a Kineflex ADR clinical trial.

Did you specifically and medically determine that your L4/5 was healthy before entering the clincal trial on your L5/S1 or did they think your L5/S1 was worse and somehow you still got into the trial when you where really a 2 level candidate before your ADR trial.

Do you understand what I'm getting at? Because the point of ADR is to preserve motion so you don't need another surgery at an adjacent level, especially so soon.

Just raises a red flag! Hope you can shed some light onto your specific circumstances.

LBP,
I am on the Keniflex/Charite study. At the time I really did need a two level. My surgeon and did speak about this and the study was for only one. He put himself out on limb and decieded to replace the worset disc which was L5-S1. The disc was totally discenagraded. We were hoping that L4-L5 would be ok.
About six months after the ADR, L4-L5 started acting up. I have not had any problems with the Keniflex disc. My opinion that this ADR is fantastic and if I could I would love to have another one.

Does this answer your question LBP. I will change my signture.

Sue S