Quote:
Originally Posted by YZ2U
YES!!! I just received information that my preauthorization request to have the Veterans Health Administration cover my Lumbar ADR procedure was approved. I wasn't sure if I would get approval because I read that the VA would not cover procedures to be done overseas and could find no one that had gotten approval domestically.
That said I'm only having ADR at 1 level (L4-L5) and my private insurer (Anthem BC of CA) denied me previously. I will continue to fight my insurance company with the hope that potentially winning approval will further push them to change their anti-Lumbar ARD policy.
Wish me luck!
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Best wishes (luck) moving forward.
Anthem Blue Cross coverage position
SURG.00055 Artificial Intervertebral Discs
Anthem B/C Position Statement
Investigational and Not Medically Necessary:
Lumbar artificial intervertebral discs are considered
investigational and not medically necessary.
Appeals may get you moved forward. The above text is from Anthem and it may or may not apply in California. I assume it applies.
VHA: I am fuzzy w/o research again. Dr. Schoenfeld, US Army in made a comment in Spine (
Note 1). I recall an AAOS meeting with military orthopaedists, fuzzy.
Check your surgeon's experience, ask how many implants in a tasteful manner, etc. VHA
Charles Rosen, a surgeon working in the VHA system, questioned ADR / TDR design, trials, etc. To Dr. Rosen's credit, he wrote "Many of these failures have been described as surgical errors in either placement or sizing, surgical approach errors, inexperience, inappropriate indications, and patient non-compliance".