This is a question that I have been thinking about too - a lot. My question is whether Medicare will cover a single level L4 or L5 ADR for a Medicare beneficiary under 60 years old. According to their own ruling they are "only" excluding those 60 or over. We know by reviewing 'ADR-Friendly Insurance Companies' in this forum, that Medicare has already approved ADR, for at least one person.
Therefore, if your daughter meets the criteria, L4 or L5, under 60, single level, I think Medicare must follow their own policy. Obviously, they just used this 60 year old "myth" to get out of paying for coverage, for the majority. The research did not cover this group, so Medicare promptly excluded the majority of their beneficiaries. Very typical for SSA. No research of their own, just an easy way to achieve non-coverage.
I would just contact Medicare and read their policy back to them (you can Google it) and ask them to cover one of the two FDA approved ADR's. They must follow their own policy, it's in their POM's. You may have to hire an attorney to have SSA "own up to" their own policy but it should not take too much legal time. Frankly, I think the media would love this story. The key in my mind is that you must be a single level at L4 or L5 or SSA will weasel out of it by being inconsistent with the FDA approval language... I think an SSDI attorney would contribute free legal time to facilitate this process if the media was involved.
Once several single levels have been approved by Medicare, my next question is whether a two level will be covered? The FDA studies allowed for two level procedures and they were successful. Once several single level successes have occurred, I think SSA will have a hard time not covering two levels.
I hope others comment.
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