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Old 11-07-2012, 09:37 PM
AmyM AmyM is offline
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Join Date: Nov 2012
Posts: 22
Default 3 discs damaged in car crash by intoxicated driver in So Cal...what to do?

Hi all,

I've visited this site several times looking for answers, but I think it's time I posted my story to see if anyone has any advice. I can't sleep for worrying about my situation & what to do, and I really need to make some decisions. I hope someone here can help!

Background - On April 11, 2011 I was hit not once but twice by a woman who was on narcotics (this was at 5 pm on a Monday as I was heading from a PTO meeting to my youngest son's tball game). She was arrested & later convicted. I was taken to the ER by ambulance in a neck brace & on a backboard, where they x-rayed me & released me with a diagnosis of whiplash. The next day they called me back for a CT-Scan but again, said it was whiplash. My doctor suggested acupuncture & chiropractic care, which I did 2x-3x week for 2.5 months. When the pain did not resolve, my doctor then prescribed physical therapy & massage. I had a massage once a week and PT 2x a week for 2.5 months, then my physical therapist released me since my condition did not improve. At this point it had been 6 months since the accident and I was no better, so I retained a lawyer and had a MRI, which showed severe disc damage at c 3/4, 4/5 & some lesser damage at 5/6 (my doctor's review of my MRI read "ouch!"). She & my physical therapist both then referred me to a pain specialist. I had paid for everything out of pocket up until this point - about $15,000 - but my lawyer arranged for a lienholder to cover my epidurals. I had three steroid epidurals in Nov/Dec '11, but my condition did not improve. The headaches were pretty much mostly gone by this point, but I still had neck pain and my right shoulder & top of my arm ached constantly (the 2nd time I was hit by the intoxicated driver I was looking back over my right shoulder, so the damage is mainly on my right side).

I took a few months off hoping that maybe things would resolve if left alone, but they did not, so in spring of 2012 I went to a neurosurgeon in Orange County. He recommended a 2-level anterior cervical discectomy with plating & fusion. I was shocked as I truly did not think I would ever need surgery. I decided to get a 2nd opinion from another neurosurgeon in La Jolla, who said he could go in through the back & clean out the discs, and that I would "probably" be fine. As I really did not want surgery, in July of 2012 I decided to try a different kind of epidural procedure through the front of my neck using a different kind of medicine. I had high hopes but it did nothing.

The pain doctor who did my last epidural suggested I see an orthopedic surgeon since perhaps they could do something less invasive. So in August '12 I saw an orthopedic surgeon in Oceanside who also said I needed a 2-level fusion (no one wants to touch the 3rd disc, as it's not as bad as the others). I didn't have confidence in this doctor's facility, so I decided to do one more consult with Dr. Regan in Beverly Hills in Oct. '12. Dr. Regan said he could do a 2-level fusion, but there was another option - a 2-level cervical disc replacement. I had never heard about this procedure before, but I liked what he told me, especially that I would not have to worry about adjacent disc disease - a real concern since I have that third damaged disc - and I really just want to go through this once. I went home, did my research & decided that was the surgery for me. I called to book it a week later, but was unable to do so as I needed approval from my lien holder. He was reluctant to back it since disc replacement is so new in the US, and not all insurance companies cover it so he wasn't confident I would get a settlement large enough to cover his costs. So I looked into my Cigna (which I had not yet tapped into for anything related to the accident), and found they do not cover cervical disc replacements, but that they might if it was one level only. Since I needed to repair two levels, I was back at the mercy of my lien holder.

After much discussion with my lienholder, and waiting 4 days for my doctor to call me back, we decided on a compromise - a hybrid surgery of a disc replacement at 3/4 and a fusion at 4/5 (again, they want to leave 5/6 alone). From what I have read, while not as good as a 2-level ADR, a hybrid is a better option than a 2-level ADCF. So again, I tried to schedule the surgery. Then I got the lienholder's estimate and it's $260,000!!! They say it's "worst case scenario" and it will be negotiated down, but I can't risk my family's financial health on this.

I have asked Dr. Regan's office to submit my insurance for pre-qualification, and they told me they can try, but that Cigna will not cover a disc replacement if you need work on more than one level, even if you are doing a fusion on the other level. Honestly, I don't think they are even going to try.

I will very likely get a settlement from the woman who hit me, possibly up to $300,000 which sounds like a lot (it IS a lot) but my lawyer will take 1/3 and if my medical bills are more than $200,000, I will end up OWING. This is to say nothing about getting compensation for my pain, time & emotional distress over the last 18 months.

I should also mention that my symptoms have been changing over the last 4-6 weeks. Where I once had pain just in my shoulder & in my arm, it's now all the way down to my hand & my fingers tingle constantly. I am very worried that I will end up with permanent nerve damage if I don't act soon. The last two doctors I saw both told me my muscles in my right side are beginning to atrophy, and I can definitely tell I am not as strong on that side. Even typing or writing for more than a few minutes hurts. So I am feeling pressured to do something soon before it's too late. Emotionally I am a wreck trying to figure this out.

My husband & I sat down last night & came up with these options:
1) I have the hybrid surgery with Dr. Regan this month and hope that the lienholder will be able to negotiate the cost down. It would be nice to at least be able to recoup the cost of the car we had to buy to replace the one that was paid off but totaled.
a. I can continue to push Dr. Regan's office to work on getting it covered with my insurance, but I am not very optimistic that they are putting much effort in it. I can't count on it happening.
b. I could find another surgeon that does ADR whose office staff might be more receptive to working with insurance, but that would take more time & could end up with the same options. I would prefer to get this taken care of sooner rather than later since it HURTS...which is a big reason for not wanting to fight with Cigna on my own.
2) I have a 2-level fusion here in San Diego. I would be pretty much guaranteed that Cigna would cover it so I wouldn't need a lienholder, and I would walk away with some cash after paying my lawyer & medical bills. However, I am greatly concerned about developing adjacent disc disease and eventually needing more surgery. I also don't love the idea of reduced mobility and the longer recovery. Finally, I think I would be really bummed out to settle for this option when I know there is something better out there (ADR).
3. I go abroad & have the 2-level ADR or a hybrid there. Pros - qualified surgeons, cheaper, likely that we could get the costs eventually covered with settlement. Cons - we'd have to pay for this out-of-pocket up front, it would take longer to arrange, plus we'd have to factor in travel time (time off from work for my husband to accompany me), inconvenience & costs, dealing with child care while we're out of the country, plus the scary what-ifs that could pop up (follow up care, what if there is a problem, etc).

None of these options are great. There's not a clear-cut answer. This is taking over my life, between the pain and having to make the right decision. Can anyone tell me what their abroad experiences have been like? How much was it, how long were you there & what about follow-up? Or has anyone had a hybrid surgery? How do you feel? Or if anyone has had a 2-level fusion, what's recovery really like? I have so many questions, and not enough answers. I am still delving into this board but would greatly appreciate any words of wisdom.

Thank you!

-Amy
Car acccident 4.11.11 - damaged c 3/4, 4/5 & 5/6
pain in neck (ha), right shoulder, arm & tingling hand
debating between 2-level ADR abroad, hybrid here in US or 2-level fusion
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