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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#1
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Hi Everyone,
I am in my second appeal with my insurance company and they are looking for any ProDisc information/studies/reports completed since the FDA study. I called ProDisc and they said Dr. Zigler had written a paper. Does anyone know anything about this? Any help or direction would be appreciated. Thank you. |
#2
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Sue,
I would start at the TBI web site, where Dr. Zigler works. http://www.texasback.com/prodisc.htm may help you out. Allister Snyder
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bi-level disc replacement Feb.12 2007 |
#3
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sue
try this web site http://lib.bioinfo.pl/auth:Bertagnoli%2CR do any shretch on any doctor if they have written any papers it should show there. chuck
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ddd 1990 2003 mri,xrays,shots,emg 2004 discogram ouch pos l4 l5 facet block neg lost all appeals BCBS 5 months of that 3 surgeons later surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5 |
#4
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Sue, what insurance company are you trying to get approved with? Is it for cervical or lumbar? I am about to try and fight this battle with mine so I'm looking for all the help I can get.
I actually have an appt. with Dr. Zigler this Monday and I would be happy to ask him about this paper if you haven't found it yet.
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- Mom_In_TX 34 yr old married mom with four kids and a full time job- I thought my pain was just caused by stress! No known accident or incident that caused my disc problem. 1st MRI in 02/05 showed C5-6 & C6-7 4.0 mm central extrusion and right p |
#5
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Hi Mom In Texas,
YES, could you please see if he has the paper and if so could you get a copy and fax it to me or let me know where I can find it. I am having two level for L5-S1 and L4-L5. My appeal is a long story - about 50 pages to be exact. My husband has UHC - United Health Care, self insured. I am more than happy to help you with your appeal. Just let me know what you are looking for or need. As a matter of fact when I am done with the process I will e-mail the entire paper/book to you and you can adjust it accordingly. My surgery is scheduled for 8/22/07. I cancelled the first time 7/25/07 because of insurance but this time regardless of the process I am going forward. I have gone from an active (swimming, biking, running) to a pill popping stoned blob- 10 months I have not posted any of my appeal woes because it is a major downer. I am in the second phase which should have been completed this past Wednesday. I called to get information and they tell me that it is still open and 15 days has not passed. I said yes it has. She says no it is 15 business days but we don't say that in the letter. Blah, Blah, Blah. Then yesterday magically, my doctor gets a call from another doctor who wants current data on ProDisc. We come to find out that we finally have an orthopedic doctor reviewing my appeal - not a dentist who reviewed and denied the first appeal. My doctor is on vacation so now I am not sure what will happen. His office manager is on top of this so hopefully, she faired better with getting the information from Synthes than I did. I cannot even get past customer service. I am in their system for a two level and they tell me - "Sorry we only help one level patients with insurance." I will be shocked if insurance approves it, but my husband is hopeful that they might approve one level. If not, I will try one more route. I found a clause in my husband's self insured plan that states: "In certain circumstances, for purposes of overall cost savings or efficiency, we may, in our sole discretion, offer Benefits for services that would otherwise not be Covered Health Services." In my appeal I did a cost analysis for a self pay fusion and self pay ADR. The fusion was significanly higher than the ADR. I could not do a comparison with insurance because the costs are based on negoiated contracted fees that I am not privy too. As you can see from my post it I get alittle animated when discussing insurance. Good luck on MondayThanks again for asking Dr. Zigler I forgot to mention, when you see Dr. Z on Monday, ask him for a copy of his Curriulum Vitae. I used my doctor's in my appeal and it is most impressive! |
#6
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Hi Sue,
Your surgery is fast approaching. I just wanted to wish you a grand recovery! Where are you having it performed? In the days following surgery, you will likely have numerous questions, and this board is so helpful and responsive, so take full advantage. I do think your pre-surgery fitness level will definitely help in your recovery rate. Best of luck!
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CindyLou bicycle accident 6/19/01 2 compression fractures, T12, L1; vertibroplasty @ above levels, 9/15/01 4/06 hip labral tear repair 4/07 Lumbar ProDisc replacement by Dr. B., 3 levels; L3-6 7/2/08 ALIF of L6-S1 7/30/08 Removed bone cement. 8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion. 3/10/09 right SI Joint Fusion; seeing light at end of tunnel, for first time in 8 years!! |
#7
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__________________
ddd 1990 2003 mri,xrays,shots,emg 2004 discogram ouch pos l4 l5 facet block neg lost all appeals BCBS 5 months of that 3 surgeons later surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5 |
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