I was approved by Blue Cross/Blue Shield March 2007 for the anterior Charite disc replacement at L5-S1 with a significant proven medical necessity. I scheduled the surgery in OKC for April 19th, 2007 with Dr Stewart Smith. I had a sinus infection therefore surgery was rescheduled for May 3, 2007. The sinus infection progressed to pneumonia therefore another re-scheduling for May 31, 2007.
I received a call from the neurosurgeons office on May 15th (2 weeks-2 days to go). They stated that there has been a "reduction in the surgeons reimbursement fee from $11,000. to $1,500.-$1,700." Of course I asked what the heck that it meant and what it had to do with me?? She stated that many of the major insurance carriers have gotten together and examined a determination of Medicare which decided that the surgeon's (one neurosurgeon and one general surgeon for the procedure) allowable fee is $1,500 to $1,700 for BOTH of their time in the OR. Insurance Cos have concluded that since Medicare decided that amount that they are only going to pay that much too. I CANT BELIEVE THIS!!!!!! My surgery has been cancelled until further notice. I immediately called Depuy/Charite Advocacy Group who knew me well as they had been ready to file appeal and fight if BC/BS did not approve me right from the start for the disc, they did not have any idea what I was talking about on the reduction of fees and immediately got in touch with the neurosurgeon's office to get the documentation from them. I called BC/BS in New York and they did not know of any problem with the reimbursement and said that it must be at the local level in Oklahoma (in-network ppo issue where all the bills for the surgery is submitted).
I went in for a follow up with Dr. Smith on May 22, 2007 and we talked about this situation, he is horrified at this development with the insurance companies!!! He explained to me that he could not work for that kind of pay which is alloted as $1500 to him and $200 to the general surgeon to open/close the patient. He said that NO general surgeon would work for that amount either. I completely understand!! This has been a long journey and I am SO mad at the insurance company that I pay $600. a month premium (by the way is on COBRA coverage and will expire at the end of this year).
I told Dr. Smith that I would wait a few weeks to give time for this nightmare to be worked out and hopefully get resolved but what are some other surgery options available EXCEPT regular anterior fusion???
Dr. Smith told me about a NEW alternative minimal invasive fusion procedure called the AxiaLIF which web site is Trans1.com. He said he had done six since the first of the year with GOOD results and said it was definately a "viable alternative to disc replacement". Has anyone had this done or know anything about it??? Please respond because I am climbing out of my skin with increasing pain and intend to call Dr Smith toward the end of this week and say "Set AxiaLIF Up for the end of the month, I can't wait anymore!!" Please help if you can.
36 year old female
5' 6" - very small framed
100# to 110# max
<LI>1990-Natural Child Birth (7# 6oz)
<LI>1994-Natural Child Birth (6# 13oz)
<LI>1989-2006 heavy lifting in career
<LI>2003-3/2006 constant Chiropractor Visits
<LI>7/2006 MRI of lumbar
<LI>8/2006- Physical therapy, cortizone injections, lots of pain
<LI>12/15/2006 Discogram of lumbar..ouch!
<LI>4/19/2007 Scheduled for Charite disc @ L5-S1
<LI>5/15/2007 Surgery cancelled for reduction of fee reimbursement
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