Thread: overwhelmed.
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Old 04-30-2015, 08:21 PM
NJ Gene NJ Gene is offline
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Join Date: Feb 2013
Posts: 376
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Dear Acronym,

Welcome to these boards!! I'm sure you'll get a lot of help here. Please realize that only about 1 out of every 100 spine surgeons in the U.S. perform artificial disc replacement surgery. The 99% who don't perform this will not recommend it. They want something that's going to put $$ in their pocket.

I am having ADR next week at C5/C6 to stop the domino effect of 2 levels of fusion above it. I will be having it done at the Texas Back Institute (TBI) by Dr. Scott Blumenthal. He is one of the first (if not the first) U.S. surgeons to perform this procedure. He works with most FDA approved devices, including the Mobi-C (that's what I'm getting). He has performed this procedure on at least one player of the Dallas Cowboys as well as one of the Mavericks.

Dr. Blumenthal does not accept insurance. However, if you have insurance that has out-of-benefits, you might be covered for all or part of the procedure. Unfortunately, I do not have this. I will be paying a flat fee of $22,375.00 This includes the surgery, hospital, anesthesia, and follow-up. I simply gave them a credit number over the phone and I will be receiving a lot of hotel points because of it. I will also be receiving a nice tax deduction when filing for 2015, as any out-of-pocket (not covered by insurance) medical expenses that exceed 10% of your adjusted gross income can be deducted on Schedule A. Because I'm meeting this threshold, all of my other out-of-pocket medical expenses (i.e. doctor co-pays, RX co-pays, lasik surgery) can be included. Since I file a joint return, all of my wife's expenses can be included as well. If you're more interested in the tax aspects of this, please send me a private message and I'll go into more detail.

That being said, there are many other excellent surgeons on these boards who do take insurance. Furthermore, you don't have the biggest stumbling block that many insurance companies still use as an excuse. Many won't cover ADR at a level that is adjacent to one where one had a fusion. This is because when the FDA first started allowing ADR in the U.S., it did not permit it in this situation. I was told that studies (which some spine surgeons who don't perform ADR tell me and believe) have shown that ADR adjacent to a fusion can destabilize the spine. Well, Dr. Blumenthal mentioned that there have been recent studies that show the opposite (ADR adjacent to a fusion adds stability to the spine) is true. The bottom line is that many insurance companies will hold on to the original FDA rules as long as possible as an excuse not to pay. Since you don't have any fusions, this won't be an issue. You may have difficulty and/or an uphill battle trying to get insurance to cover multiple levels, but if stick to the one you were told was causing the most difficulty with your nerves, you should have no problem.

BTW, I'm sure if you send a private message to Harrison or Cynlite, they will gladly send you a link to ADR surgeons throughout the U.S. Finally, I could have searched around for a surgeon who might have accepted my insurance, but I know I wouldn't have it covered as Blue Cross seems to make an issue of this adjacent level thing. I could have fought and possibly prevailed, but you know what, I am tired and don't feel like fighting. $22K to have this procedure one of the best ADR surgeons in the country (if not the world), which is tax deductible, is money well spent (in my opinion).

Good luck!!

Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4
1998 Larger Herniation and Cervical Fusion C3/C4
2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007
2008 - Foraminotomy at C6/C7 on left side
Feb, 2010 - Cervical Fusion C4/C5
Dec, 2010 - Lumbar Fusion L3/L5
2013 - Bulge on C5/C6; herniation C6/C7 right side
Mar 26, 2013 - Foraminotomy at C6/C7 on right side
May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
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