Hi Mom In Texas,

YES, could you please see if he has the paper and if so could you get a copy and fax it to me or let me know where I can find it. I am having two level for L5-S1 and L4-L5.

My appeal is a long story - about 50 pages to be exact. My husband has UHC - United Health Care, self insured. I am more than happy to help you with your appeal. Just let me know what you are looking for or need. As a matter of fact when I am done with the process I will e-mail the entire paper/book to you and you can adjust it accordingly.

My surgery is scheduled for 8/22/07. I cancelled the first time 7/25/07 because of insurance but this time regardless of the process I am going forward. I have gone from an active (swimming, biking, running) to a pill popping stoned blob- 10 months

I have not posted any of my appeal woes because it is a major downer. I am in the second phase which should have been completed this past Wednesday. I called to get information and they tell me that it is still open and 15 days has not passed. I said yes it has. She says no it is 15 business days but we don't say that in the letter. Blah, Blah, Blah.

Then yesterday magically, my doctor gets a call from another doctor who wants current data on ProDisc. We come to find out that we finally have an orthopedic doctor reviewing my appeal - not a dentist who reviewed and denied the first appeal. My doctor is on vacation so now I am not sure what will happen. His office manager is on top of this so hopefully, she faired better with getting the information from Synthes than I did. I cannot even get past customer service. I am in their system for a two level and they tell me - "Sorry we only help one level patients with insurance."

I will be shocked if insurance approves it, but my husband is hopeful that they might approve one level. If not, I will try one more route. I found a clause in my husband's self insured plan that states: "In certain circumstances, for purposes of overall cost savings or efficiency, we may, in our sole discretion, offer Benefits for services that would otherwise not be Covered Health Services." In my appeal I did a cost analysis for a self pay fusion and self pay ADR. The fusion was significanly higher than the ADR. I could not do a comparison with insurance because the costs are based on negoiated contracted fees that I am not privy too.

As you can see from my post it I get alittle animated when discussing insurance.

Good luck on MondayThanks again for asking Dr. Zigler

I forgot to mention, when you see Dr. Z on Monday, ask him for a copy of his Curriulum Vitae. I used my doctor's in my appeal and it is most impressive!