I'm pretty upset~ WC is no longer offering to pay for the ADR surgery. It will pay for fusion or "other options"...

I've hung every hope I had on this surgery and the possibilities it yields altho I've been badly burned once before w/failed back surgery resultant bad burning pain in glutes, quads, and calves for years afterwards hence my hesitation for more surgery. Also experienced intense low back pain (DDD, disc bulging, anular tear) that is disabling and causes me to spend too much time horizontal..

Back pain, an unwelcome undesired way of life for me since 1982...

My only other medical insurance is MediCare which won't pay for anything on my low back as this is a WC case.

Well, dejection isn't a big enough word for me to use to express how I feel right now, time to go off on another crying jag.. later http://adrsupport.org/groupee_common...n_rolleyes.gif

Maria,

I am so sorry to hear WCs decision. This is flat out ridiculous. http://adrsupport.org/groupee_common...s/icon_mad.gif I wish I was able to offer more..ehhhh

Keep your head up--this isn't the end of the road.

Justin

Hi Maria,

What is your relationship with your workers' comp. case worker? Do you also have a nurse case manager? I appealed my case to the state board and requested my case to be reviewed by a state certified orthopaedic surgeon. The surgeon supported the recommended ADR and WC was obligated to pay. Please don't give up yet. You may need to write some more letters or make some more phone calls, but it's worthwhile. Hang in there!

I've had a Nurse Case Manager for quite some time now. I was originally told by WC back in 12/03 after seeing Dr.Bradford in SF that the 2 level ADR pro disc trial would be authorized. A surgery date was set, but they canceled as the trial shut down early. So then I saw Dr.Bae at The Spine Center who recommended the same thing. This time the surgery went thru UR and was denied by the State certified orthopedic surgeon.

My Nurse Case Manager is very much in my corner, however, there are some new players at this company in positions of power and I think in position to "clean up cases". I'm known as a "lifer" as my case dates back to 1982 and I have Lifetime Future Medical Benefits. Also I'm an RN,NP who has been out of work since 2000 so while I would like to go back to work, there is no push for WC to try and get me back to work...

One thing that was mentioned was if I was a single level ADR case this surgery could be approved but being multiple levels ...fusion was my option or "other"...

There's more, will write more tomm. Am very tired so need to sleep before writing anything else..

Maria,

I just don't understand the rationale here for this denial - especially since you were approved before for this ....Hang in there and keep fighting. What they want you to do is give up - don't do it!!!

Hi Mariaa, The monkeys running the kangaroo court don't want to hear anything about 2 level, non-FDA approved Charite single level. That was my experience with WC five days before my ADR. They told me to cancel surgery and get a Commssioners Evaluation. That was in June. I probably wouldn't have had surgery by now if I played their game. I have a few really good attorneys in my corner that don't do WC so I value their opinions. They all say it is not a matter of if you will get screwed, the variable is only how much. I tried to organize a march to the Gov's office last month, there were no takers. That is not because there are not people hurt like you and I, but because they isolate us. They want us to give up. I once was told by my Senate Aide that my "problem" was I don't give up. I recently received copies of my bill and it looks like there is a Medicare denial in my file for 2 level. I was not aware this had been officially submitted. Don't give up, it is only the beginning.

Poncho and JL,
Thanks...I was able to sleep fortunately however haved awakened in a sobbing state.. I'm hoping some coffee and Miralax will put a smile on my face so I can at least go out and do what I have to today..

RE WC..I guess my wait is on for a bit longer as Charite device is FDA approved and how it's used is the Surgeon's perogative I believe at this point.

I told my Nurse Case Manager last night that when the 3level global fusion was offered to me, I reviewed the literature on this and even the device literature itself stated that it was not recommended for use w/Multiple levels yet surgeons were utilizing the cage at the levels they felt they could as it was an FDA approved device.

I think the WC arguement is flawed at this point, however, will become obsolete in a matter of time. Question is, will my body hang in there till then and not further damage surrounding structures/facets...

I'm really blown away and saddened by this latest rendering however, tenacity is one of my better qualities...

Hi Maria,

Sorry about that last post; I pushed the wrong key before I was finished. My sister is being told that because she's on WC and needs two levels, she can in no way have ADR. I am trying to convince her to go with one level ADR and one level fusion instead of two levels fusion. Have you thought about that? It might be quicker and, though not ideal, less problematic for the surrounding discs in the future. My heart goes out to you.

Maybe this is a great time to review other options? If two great US ADR surgeons think that your are an excellent candidate for a 2-level ADR, then maybe it's time to balance your lifetime future benefits against a 2-level ADR with Dr. Bertagnoli? One one hand are the future lifetime benefits which have the risk of being discontinued or curtailed due to our lovely government cost-cutting. On the other hand are the very real risks of a major spine procedure. Can't tell you which one outweighs the other (no one can - only you and God know), but, both risks are real and present.

Maybe some serious analysis of your options (you've still got them) and some dedicated prayer might bring new (and possibly even better) ideas to light?

Prayers and best wishes to you,
Laura

Maria,

Hang in there and don't give into the frustration and negativity. You have made it this far and you can overcome this obstacle. Keep searching for solutions and keep dialogue open with your case workers. Is it possible to have your case reviewed by another state certified orthopaedic surgeon? If the state board recommends the 2 level ADR you can bypass UR. I will keep you in my thoughts and prayers.

Mariaa,
I`m so sorry to hear this, maybe its a "Breathing space" which might just help you.

You have been around a long time and this seems so cruel - -- - I hope and pray you will get a "Change Of Heart" from this organisation
Best wishes
Alastair http://adrsupport.org/groupee_common...icon_smile.gif

Maria
I am so sorry to hear this! I hope and pray that you get them to change their minds and soon. Its not enough to be in constant pain but to have to deal with the pains that ins can be is so unnecessary in my humble opinion

Maria,
I'm so disappointed to hear about this denial. I think Mars has a good idea. Will they consider 1-level fusion and 1-level ADR? Would you ever consider multilevel fusion? ADR seems just as dicey as fusion to me.

Jim

I think eventually that ADR will become a standard of care for ddd just as certain fusion techniques utilized today - right now, I think the game is all political and unfortunately it is patients that end up paying for all of this - Whether it is actual out of pocket costs vs chronic pain vs everything that comes with being disabled or practically disabled (AKA Red tape).

I could drone on, but I think I've said enough http://adrsupport.org/groupee_common...icon_frown.gif

Hi Maria. I'm sorry to hear about your problems. Is it really any wonder that depression's linked with back pain when we have all these external pressures to deal with - it's not depression, it's plain old stress! http://adrsupport.org/groupee_common...s/icon_mad.gif http://adrsupport.org/groupee_common.../icon_wink.gif I've been feeling as if having ddd is a constant battle but at least we don't have to jump through all the hoops you do in the States.

I agree with Poncho that eventually ADR will become the norm. With about 200,000 fusion patients a year in the USA I can't help but wonder how many will end up having ADR instead. I know it's not much consolation now but when you win the battle you'll know that you've just taken the system one step closer to removing these barriers for other patients (or am I being too naive about the US system http://adrsupport.org/groupee_common...n_rolleyes.gif ) not to mention you'll be on the road to recovery http://adrsupport.org/groupee_common...icon_smile.gif In the meantime keep your chin up and good luck! http://adrsupport.org/groupee_common...icon_smile.gif

You/'ve been taking your time to research all your options and this is just unfair not to have a chance to get the best surgery for you. If you can see another surgeon for opinion maybe you can talk in terms of returning back to work if you could get the correct surgery in order to recover. Quality of Life is more important than working and I'd argue that point also. I'm sorry that you have go through all this but something will work out.