HIP/Emblemhealth, anyonr have any luck?

[ADRADR]

So I'm at the point that I have consulted with Dr. Rischke and have submitted my information to Clavel/Ritter-Lang for a consultation once my medical history is reviewed. My insurance is HIP/EmblemHealth, a mediocre provider in NY. My plan does cover the FDA approved ADRs but I think they are not good devices. Anyway, obviously insurance is paying considerably less to a surgeon abroad than surgery in the US, and the devices and surgeons are generally better, so it should be win-win, but unfortunately the world doesn't work like that. Has anyone ever had luck with this provider? Any advice on how to fight with insurance for a foreign ADR? If I schedule surgery for January I can probably save 15K, but its still not nearly enough. Maybe take out a loan for the rest but that's not ideal either. Any advice on how to come up with the money?

[NJ Gene]

ADR,

Before making the decision to go overseas, there are several good surgeons to consider in the U.S. The first one that comes to mind is Dr. Jack Zigler of the Texas Back Institute (TBI) in Plano, TX. The reason I am suggesting TBI is that they are known for helping the patient through the insurance process. Furthermore, they do excellent work. There are some very good ADR's like the ProDisc used in the U.S. There are many other U.S. surgeons who perform ADR. I suggest you spend some time researching these boards.

In terms of going overseas, the M6 may be one of the best makes out there. You need to get multiple opinions from surgeons in Europe as well as the U.S. Certain conditions prevent people from being a candidate for the M6 and in some cases ADR altogether. By the way, when you mentioned that you sent your MRI to be reviewed by Clavel/Ritter-Lang, I hope you sent your MRI to Clavel separately. If you sent them to Ritter-Lang (probably through Sue Hart) on the Artificial Disc Replacement Surgery website, Clavel will never see those films. If you want Dr Clavel to see your films, you should check out this site: Barcelona Spine Center | Barcelona Spine Center and contact his team through there. Dr. Ritter-Lang may have may have been a great surgeon at one time. However, he has a very bad reputation on these boards. Patients feel like they are in an assembly-line being treated by him and his team. He typically does 6 to 7 surgeries a day. Most other surgeons do 2 to 3 in a day. Don't get me wrong, most patients improve with Ritter-Lang. Bad discs are removed and replaced by good ones. However, placing the discs requires a certain amount of precision, which can be compromised if one rushes through the process. Other surgeons in Europe to consider are Dr. Bierstedt in Germany German Spine Specialists – M6 ADR Artificial Disk Replacement - Stop spine pain now, Lumbar Cervical Spine Surgery and Mr. Dare in Southampton, UK. From reading these boards, Dr Clavel seems to be fantastic. Not as many people use Dr. Bierstedt, but everyone who has used him only seems to have good things to say about him. The same holds true for Mr. Dare.

One last issue regarding insurance. Most people who go to Europe are in severe pain and seem to have no other alternative than to travel there. There are a few cases where people get lucky and get reimbursed by insurance. Blue Cross/Blue Shield has some sort of international plan and those that have policies with out-of-network benefits sometimes get reimbursed. However, nobody I know of on these boards has gone overseas with pre-approval from their carrier. You need to go over there with the expectation that you won't get anything from your insurance. If you do, then you can consider yourself lucky. The positive thing is that you can take most of your medical and travel costs as a deduction on your tax return. The downside is that if something goes wrong there is no accountability like there is in the U.S. Furthermore, finding a U.S. doctor to do follow-up on surgery done overseas is very difficult.

In summary, I recommend you try and find some U.S. surgeons first. Then if you determine that you need to go overseas, I suggest you consider Dr. Clavel through his own website that I gave you or the other surgeons I mentioned. Finally, stay away from Dr. Ritter-Lang at all costs!! Compare his recommendation of treatment to others, but don't use him.

Good luck!!
Gene

[TPatti]

What NYGENE said-

[ADRADR]

Dear Gene,

Thank you for your response. I understand I am not in constant severe pain and disability at the time, but its been basically determined that it will not get better and is going to continue to get worse over time. Little evidence supports that waiting is the best option, aside from to avoid risks with surgery -- the likelihood for a good outcome decreases. Things I love are no longer options, and that is unacceptable for me, and worth the risks associated with surgery to correct. Anyway I appreciate your advice, and I have given everything months worth of careful consideration as far as whether I want to do the surgery. If I am able to get the money together I've already decided that I want to do it. I miss living my normal life too much, and have little value for the life I live now.

I've come to that conclusion about Ritter-Lang and Clavel, but didn't know there was a better way to reach Clavel so thank you for that.

With regards to surgery in the US, if I'm going to do this, I'm going to either stack the odds in my favor or not at all. I am far too young to let anyone put a ball and socket design in me I think. I feel as if long-term results will be questionable. I think the Freedom disc is going to end up the best disc on the market, but I haven't read many reviews from people who have seen Rischke which concerns me. The M6 is also very good minus the amount of disruption to bone and precision required for placement, and Clavel has outstanding reviews.

I can probably save enough money if I did the surgery a year from now, so if that's the option than I'll take it, and I think by that time it will be more certain whether ADR is the best option, even though I already personally believe it is. The longer I wait, the more likely more degenerative changes to other structures.

[NJ Gene]

ADR,

What you said sounds reasonable. It's not clear which levels you have issues with. You mention some neck pain and back pain, so I'm guessing you have more than one that needs addressing. Since you seem set on Europe, know that for every dollar spent and not reimbursed by insurance, the costs are tax deductible for every dollar spent above 10% of your adjusted gross income (i.e. If you're total AGI is $100,000 per year and you spend $30K on medical costs, you can deduct $20K on Schedule A of your return [10% of $100,000 = $10,000; $30,000 - $10,000 = $20,000] Furthermore, you're not limited to the costs spent overseas. Every dollar spent at home by you or any member of your family (assuming you file one return for your family) for any type of medical related cost unreimbursed by insurance is deductible (i.e. doctor co-pays, prescription co-pays, eyeglasses, hearing aids, mental health, etc). That's the C.P.A. in me speaking.

Best of luck. Many people on here have used Dr. Clavel. However, Lillyth had 6 levels done by him and has wonderful things to say about him. You may want to PM her with specific questions about her experience there.

Cordially,
Gene

[ADRADR]

Gene,

Thanks so much for the advice about taxes. I have one level which is bad, C6-C7. Got two opinions here, both agree only that level. So right now my income is about 46K. If the surgery was 40k, what does it mean to deduct that from my taxes? Like how does that deduction come back to me? I'm considering taking out a loan for what I can, and paying it back ASAP would be good.

[TPatti]

Originally Posted by ADRADR

Gene,

Thanks so much for the advice about taxes. I have one level which is bad, C6-C7. Got two opinions here, both agree only that level. So right now my income is about 46K. If the surgery was 40k, what does it mean to deduct that from my taxes? Like how does that deduction come back to me? I'm considering taking out a loan for what I can, and paying it back ASAP would be good.

Gene can most likely answer better, but my stab at it would be that if everything after 10% was deductible you would be taxed on $1400 of income.
Gene: I have also heard that it was not a percentage but will be all expenses over $11,500 for next year.

[NJ Gene]

ADR, Based on your income of $46K and a surgery cost of $40K, you could deduct $35,400 off of your Schedule A for medical expenses [$46,000 x 10% = $4,600; $40,000 - $4,600 = $35,400] Hypothetically, if that were your only expenditure on Schedule A (which it probably isn't) you take that $35,400 deduction and add the $3,700 personal exemption that everyone is entitled to, and your taxable income will be $6,900. However, I don't think you're including additional medical costs in the U.S. that I mentioned in my previous posting. Also, unless you live in a state that has no income tax, you can deduct taxes paid on your Schedule A as well. There is a good chance that your taxable income could effectively drop down to 0. You can only go as low as 0. There is no such thing as negative income on one's tax return, with a couple exceptions for people who live in poverty. The bottom line is that every dollar that you have withheld from your paycheck in taxes will be refunded to you.

TPatti, you came close on the amount of taxable income. However, I do not know where you heard of that $11,500 threshold. Beginning with tax year 2013, the threshold for medical expenses increased to 10% of AGI. Prior to 2013 it was 7.5%. It had been at that level for at least 25 years (I graduated college in 1988 and it was 7.5% then). Senior citizens still have a few years where they can use the 7.5% threshold. Take a look at this link off of the IRS website: 2013 changes to itemized deduction for medical expenses

In simple terms ADR, the government will effectively be contributing $12K towards your surgery.

Gene

[ADRADR]

Gene,

That information is incredibly helpful, thanks so much

[NJ Gene]

You're welcome ADR. Feel free to send me a PM if you want to go over more of the details.

Gene