[asdals]

Hi - I was just glancing thru this thread and have some information that may or may not help. I'm going to just share what I've been thru and you can let me know later if it made a difference.

I've been thru a 10 year struggle with my neck and have Degenerative Disc Disease in C3-C7. I've seroiusly contemplated surgery for the past 3 years. I also have occipital headaches - basically one continuous headache which is a large part of my pain.

Anyhow, my Neurologist broke his C1 in a surfing accident about 4 years ago. During a botox session (headaches, not beauty), I asked him who did his surgery. His surgeon was Dr. Frank Coufal of LA Jolla Neurosurgical Associates. I met with Dr. Coufal shortly after and found out that he had participated in the clinical trials for 2-level ADR. When I first met him -April 2013- he said a 1-level ADR/Fusion would help, but a 2-level ADR would be even better. He said they submitted for approval from the FDA in 2007, but had no idea if/when they would approve it. I decided to wait it out and see how my symptoms progressed.

In January of this year, my symptoms became debilitating. I'm used to the headaches and they are painful, but the shooting pain and numbness from my upper right scapula thru my shoulder, arm and hand was unbearable. It was coming from my C5 and I decided then that I was ready for surgery. In the meantime, my pain specialist was able to give me a series of 3 epidurals going in underneath C7 and shooting up into C5-6. After the 3rd round, my symptoms were under control. At this point, I was ready to get the surgery done, but only if it was a 2-level ADR.

Dr Coufal's office submitted the insurance request for surgery in late January to our Aetna PPO insurance. They immediately denied it as well as a peer-to-peer review saying it was "not medically necessary". We submitted a written appeal along with records from 3 other doctors all recommending surgery on Feb 26th. What still angers me is that my exact symptoms and diagnosis were almost word-for-word what Aetna defined as "medically necceassary".

Back to my long story, Aetna literally sat on this appeal saying the department who makes the decisions was "very backlogged". This lasted thru the end of August. I called over 20 times as did my Dr's office. The people in customer service were very friendly and sympathetic, but weren't even allowed to communicate directly with the appeals group - they are untouchable and unaccountable! I had a manager of the customer service group calling me every Thursday since mid-July to follow-up. Each time, he was more frustrated and even mentioned that people were annoyed with him for pushing. The director of the appeals group was aware of the urgency of my case and how long I had been waiting, but never did get a decision made:-(

Then, a miracle happened. My husband's employer decided to switch insurance carriers. Aetna was raising their prices by 30%, so they switched to United Healthcare. Our new insurance (UHC PPO) became effective on September 1st. I gave Dr Coufal's office the new info in September 7th and made an appointment to start the process all over again. 10 days later, I got a call from Dr Coufal's office letting me know that UHC had approved my surgery!!

My surgery is scheduled for October 9th and now that I know it's coming, I'm getting nervous. I've dealt with this pain for so long and am so ready to be done with it. I've had so many injections - epidurals, nerve nlocks, facet blocks, radio frequency and botox (70 pricks every 3 months alone!). Those have been no big deal, but thinking of the surgery....well, I'm trying just to think of the hopefully very happy outcome and not the process!!

Well, now I have a huge headache from looking down at my cell phone and typing this. I stopped working in 2008 bc my headaches were so bad. I vowed then to spend as little time as possible on my computer, but my cell phone probably makes my head hurt more! I apologize if there are any typos. We'll blame it on the cell phone!

Take care and please feel free to share your experiences in more detail. Misery loves company!!

Amy