[rickz68]

All,

First, I wanted to thank everyone for posting on this site. It is a great source of info as well as a good anxiety relief knowing that most of the questions I have can be answered via the posts on this site.

I haven't posted much on this site so I want to take this time to tell you a little about my story/saga.

I've had back pain since I was about 18. I think it's a result of a fall down some concrete steps in the Chicago winter when I was about 15. Since then I remained very active palying all sports and the pain would come and go. I mostly ignored it. Then in '99 I was playing some basketball and my back just went out. My feet felt like they were concrete blocks. The next two weeks were pretty much terrible. Since then I have been in a lot pain and have tried every posible therapy I learned about including VAX-D, chiro, massage and 7 epidurals.

Anyway, I learned about ADR in '01 thru Dr. Lytton Williams at USC University hospital. He wanted to perform a fusion. I decided to hold out for something better.

I started fighting for the ADR surgery in March '04. At the time the procedure was experimental and I was immediately denied. Immediately after FDA approval I had my surgeon, Dr. Regan, resubmit. I was again denied. I decide to wait several months and resubmit. Each time I was denied I would appeal and get denied again. I then would go thru an IMR and get denied again. I was adamant that I should not have to pay for a proven FDA approved procedure. I decided to wait for the procedure to gain some momentum and in July of this year I once again had Dr. Regan's office submit for the surgery. I was denied. This time I wrote a more precise, fact based and filled, two page letter inquiring how they could deny me as well as requesting a detailed review process with a spine specialist. (I have to mention that I have to thank John Argiro at DePuy spine. He has helped me thru this process with advice and info.) To my surprise, two weeks after they received my letter, I received a call from Health Net stating that the denial was overturned on the basis of a specialty match review. In all I was denied by Health Net 5 times and by the Dept of Managed Health Care twice in the span of almost 1 year and 5 months.

I must say I still don't believe they approved my surgery. I think I am the first person that Health Net has approved. The doctor's office doesn't believe it either. But we are moving forward. I have a scheduled surgery date of Sept 13. I am a little scared but have fought too hard to stop now.

Once again I want to thank everyone for posting.