[LBP]

You are the first person I've ever heard of that has been denied ADR surgery with Aetna. I had a 2 level lumbar and there was no fight, no appeal, just approved immediately once I finally got them as my insurer. As my profile states, I had no luck with my appeals through Pacificare and UHC AND IT all changed with Aetna, and I picked Aetna based on comments from people on this forum who had Aetna.

What specific Aetna plan are you on? That may have something to do with it. Do you have a PPO, an HMO, and did you select the least or most expensive option, is it through your employer? are you limited to one plan with Aetna?

I dont know much about the differences of ADR for cervical vs lumbar, but at the time I was approved, Prodisc lumbar was still only FDA approved for 1 level, I don't think the FDA has yet approved the 2 level arm of the Prodisc clinical trial.

the only other thing I can think of is your surgeon. Maybe that weighs into the equation??? I picked a surgeon who participated in the 2 level lumbar Prodics clinical trial so he was very experienced in the procedure. I have no idea if that matters. I had the same surgeon when I tried to have a 2 level Charite (before prodisc was approved) but UHC denied it.

Which disc are you trying to get and what is the FDA status on that disc or other disc implants. I honestly don't know why you are hitting a wall. I am surprised that no one else has posted with a similar aetna story. Have you done a search with Aetna? I haven't monitored this forum as much since I had my surgery but before my surgery, Aetna was the only company consistently giving a green light.