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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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#11
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Fda
Commissioner’s Page
HUH? I thought this was the United States FDA? |
#12
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I have just sent a 40 page, professionally bound and printed brief to BCBS appealing their denial for a multilevel ADR using the M6-C device.
I hope to hear back from them soon. http://www.spinecarealliance.org/wp-...ay-for-ADR.pdf
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C 3-4-5 fusion circa 1981 2 Spinal Kinetics M6-C's at C 5-6 and C 6-7 |
#13
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Jerry,
I think this might be GOOD news. They may finally be realizing that our healthcare is so far behind-the-times, they are willing to be a part of a global health care standard that will bring more modern medical technology to the United States seamlessly. This is would good for all of us. They have to see how people have been taking their problems(and there MONEY) overseas due to our ancient health care system that has a huge Berlin Wall between it and the rest of the world. Hopefully the FDA is looking to knock that wall down and give people a reason to stay and put trust into our health, and give flexibility to advancing medicines. SOMETHING HAS TO GIVE SOMEDAY.
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2013 - MRI and CT scan....DDD L4-S1 left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine. |
#14
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VA Fusion
Thank you again 2Confused,
Sure enough, all that time and the VA will only consider a fusion, two weeks in a bed and 3 months with a brace. They say it is not recommended, and are seeing more failures? Not to say the Charite and ProDisc are NOT working, but I have talked to a few and these are tearing up their facet joints. I had another MRI, in mid Jan, and the report from the person doing the eval of the MRI, said I had significant deterioration of the facet joints, and I have only had decompression surgery. There are MANY people that have the M6, and are doing real well. If anyone knows someone that has the M6, (especially in the Lumbar, in my case) and have had an MRI post op, a couple of years later, let me know if they have nn improvement in the adjoining areas, or at least not worsening. I submitted my BC international claim this week and suspect I will get the Usual response, investigational. Will post as I can.
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Jerry, Somewhere Ohio L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior. Last edited by Jerry5; 03-11-2014 at 08:58 PM. Reason: grammar |
#15
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Worldwide Blue
Hi all....
I have no real answers, but I understand there are others who have received anywhere from 60% to 100% reimbursement from Worldwide Blue... Keep appealing!!!!
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50 year old female Rear-Ended in 2009 Disk rupture cervical 5-6 & 6-7 2 level M6 ADR, Dr. Clavel - Oct. 2012 Insurance paid Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel Post Op 2+ years Cross Fit 3-5 times a week Running 5ks |
#16
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If it is of any help to anyone, PubMed has dozens of studies about ADR.
There is definitely no lack of information that ADR works! If I get denied during precertification for my lumbar ADR I plan on printing out all of the studies and sending it in. ( not that I think they would take the time to read them ) I also read somewhere awhile ago that most of the time the "doctors" on the insurance review board are either not reviewing cases that are in their field of specialty, or are old school, some are even retired, and you have the right to know who is reviewing your case. But as far as PubMed goes, I just did a search for artificial lumbar disc and tons of studies came up - most with positive results. It just flabberghasts me that Europe has been doing ADR since the 80's and the insurance companies here have such a hard headed approach to it. It's all about how they can make the most money - gag.
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6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present. Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5. |
#17
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Quote:
The artificial disc is contraindicated if the facet joints have significant wear. That is why I was told, by top surgeons, my best chance would be a 1 level fusion at L5/S1, and ADR at L4/5. However I have to switch insurance because there has been no luck with Oxford covering this procedure. Good luck with your insurance, though! Reqmt
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6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present. Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5. |
#18
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Reqmt: I just had a fusion at the L5-S1 due to my bone density test a few weeks beforehand. I was so disappointed that I couldn't get the ADR but to be honest, I was kind of relieved because I didn't feel a warm fuzzy about the Pro-Disc L. It's been a week now and I feel great. I think I may have full mobility but don't want to rush things. I will have to wait until my surgeon gives me the go ahead or when I am in PT.
As far as the ADR is concerned, I also had a multi-level ADR at the C5-7 using the Mobi-C and that seems to be going great as well. All done in the USA and my insurance is covering everything but my co-pay of $11.00 per day for three days in the hospital. A friend came over yesterday and couldn't believe that I was up, dressed, cooking Tortilla soup and the house was spotless. I believe it all has to do with the surgeon you choose. I don't see a reason to have to go all the way to Europe to get these procedures done and pay out of your pocket. If your insurance denies you then keep on fighting. It took three appeals for me before I won. I am happy with my choice and haven't looked back. Whatever you do keep fighting. Good luck!
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1998- Injured neck and back in USAF 2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica. Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA ) July 2014 - Stem Cell Procedure performed Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy |
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