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Old 11-22-2017, 09:28 PM
ia75 ia75 is offline
Junior Member
Join Date: Oct 2017
Posts: 16
Default Out of pocket

Originally Posted by ouchtear View Post
After months and months of internal appeals and finally a external appeal from New York state it was finally denied. I was going to have a one level l5-s1 done with either a Prodisc L or Activ L at the Texas Back institute. It's such bull****.. No evidence to support it is better than fusion... Then with that logic there is NO evidence to support that it is worse. So then let me chose then... I guess I am at square 1 again.. I may just take a gamble and pay for it out of pocket somewhere...submit it and then fight them like hell to pay for it..
TBI charges $36,000 for a one-level ADR...
42 y.o. female, athletic build, otherwise healthy
L5-SI: Severe DDD with subtotal disc collapse, mild to moderate bil. foraminal stenosis.
2007: car accident, mild herniation, intermittent pain.
2012-17: pain chronic, progressive, resistant to conventional treatment.
06/2017: Discogram, MRI
10/04/2017: ADR surgery denied by BCBS (FEP),

Pain is severe and disabling
04/04/2018: ADR surgery using LP-ESP disc with Dr. Desai
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