Hi Kelly,
I just posted in another thread some of the appeal variables that may come into play when looking at outcomes. These include insurance carrier, type of procedure, number of disc levels addressed, support by local docs, and many more. However, I also agree with you that there is some randomness as there are different reps within the insurance carrier reviewing the appeals, different moods they are in, etc.
Bottom line in my opinion is that it is worth it to try to obtain approval or be reimbursed for the surgery. It is also important to manage one's expectations so that you are not terribly disappointed if you are ultimately denied.
Incidentally, Cigna does not accept 2-level cervical ADR as there guidelines have many exceptions. I suspect that it can be random as well.
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1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.
New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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