View Single Post
  #14  
Old 04-07-2007, 08:38 AM
CindyLou's Avatar
CindyLou CindyLou is offline
Senior Member
 
Join Date: Mar 2007
Posts: 627
Default

Judy, as far as my understanding of the conditions for them paying, I think that is what they are saying. A few posts earlier, I think it was Kevin saying last August one lumbar prosthetic device was going for about $5800. By now, I'm going to guess $6,000, so x 3= 18,000 we have to pay. (which like you said, money is money,but in my book, $18,000 is still alot and we're not done calculating yet ). Then, the kicker, we also have to pay for Dr. B's incremental expense for the time it takes him to implant them. My guess is it's going to take a whole heck of alot more time to implant those (since I need 3 lumbar discs replaced) than to do one L6-S1 fusion. (if it is deemed necessary) But, let's play off the scenario that I do have the one fusion...and no additional costs (i've already prepaid Pro-Spine $50,000 for the down payment),so by my calculations $50,000-18,000=32,000 refund minus Dr. B's time, for installing 3 adr's = the million dollar question!...I have no idea. Let's throw out a crazy low number: $10,000 for his time. (this may be laughable) Then you take that to our equation table: $32,000-$10,00= $22,000 coming our way. Finally, if those are our out of pocket expenses and the co. pays half of $22,000+ 11,000=$33,000. Then we are finally only out $17,000 out of pocket.(50-18-10+11= 33) And what if his time is way more than $10,00? Of course this is not taking into account 3 week hotel stay, food, airfare, etc. You are right...it is better than nothing. I'm not denying that. I just really wanted a big win, a win that would help pave the way for all of us needing ADR. I had my sights high,no doubt, like everyone I'm sure; I really researched, and wrote a thesis on my insights and personal history, like everyone else I'm sure. Insurance is just dragging their feet! The statistics are there! They are just hiding behind experimental and investigative! The big question: how long can they hide?? That's it. That's my story and I'm sticking to it. Thanks for your input Judy. Totally changing the subject: is it possible to pull a loose top over my head after lumbar surgery, or should everything be front buttons and zippers?
__________________
CindyLou
bicycle accident 6/19/01
2 compression fractures, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. B., 3 levels; L3-6
7/2/08 ALIF of L6-S1
7/30/08 Removed bone cement.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion.
3/10/09 right SI Joint Fusion; seeing light at end of tunnel, for first time in 8 years!!
Reply With Quote