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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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  #1  
Old 04-29-2007, 02:15 AM
motorman_darian motorman_darian is offline
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Aetna finally agreed after 8 months, 2 doctor opinions in CA (I'm in Alaska), and 1 lawyer (who hasn't really helped at this point) to cover 1 ADR at L4-L5 and fusion at L5-S1. I believe this known as a hybrid. I'm 34 years old and I'm very concerned about the limitations a fusion presents. Has anyone else had this? I would prefer ADR for both levels, as it's less expensive, preserves flexibility, seems to have less pain and recovery time, and gives me more options if technology significantly improves in the future. Are my perceptions accurate? Can anyone help me gain approval for the 2-level ADR?
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Old 04-29-2007, 04:36 AM
chasswen chasswen is offline
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motorman
many people do very very with a fused s1 and adr at l4. as the s1 joint doesnt do much movement only diff being your recovery may be a bit longer. just my 2 cents.
and food for thought there has been a few people that have gotten aetna to pay for multi level prodisc off label you need to dig thought these posts to find them. but the option aetna has thrown your way isnt bad either.
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
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  #3  
Old 04-29-2007, 06:09 AM
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Terry Terry is offline
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I believe the solution has to be your choice but have read from several that the hybrid is a good solution.

I was lucky, fortunate, amazed, stupefied, shocked, etc. that Blue Cross paid for my complete 4 level ADR Surgery. Highly unusual unless my friends in high places carried some weight; i.e., a board member sells alot of Blue Cross Insurance and asked them to review my case when it came across their desk. I believe this helped immensly as they paid after two denials.

Fight or take what you can get.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #4  
Old 04-29-2007, 04:16 PM
SeanTheFireman SeanTheFireman is offline
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Hey Motorman, As you read in my posts I have had a hybrid surgery about 2 months ago. For me it was a great success. I am doing so much already, and no longer have any pain! I have been doing stuff since 2 weeks post-op. My flexibility is getting better and better every day. It did take about a month before I was able bend down far enough to tie my shoes.
As far as insurance goes, I had the same issue, they would not pay for a 2 level ADR but they did pay 100% for a hybrid.
I am very very happy that I went forward and got the hybrid and would suggest it as an option. I also suggest that you talk to a few different Dr's and get their opinions. You gotta do whats right for you, and only you and your Dr's can decide that one.
Good Luck,
Sean
__________________
Oct 2005- Repurtured L4/L5 & L5/S1
Oct 2006 -Discogram
Hybrid Surgery Feb. 21, 2007 at New England Baptist Hospital in Boston
Charite ADR at L4/L5 and Fusion at L5/S1
Workers Comp paid 100%
Feeling Great!!
Contact me with any questions either o
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Old 04-30-2007, 01:29 AM
epiphaknee epiphaknee is offline
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There is someone else within this specific section that has received approval from Aetna for a two level ADR Pro Disc L. I would contact that person directly.

Does anyone know if Pro Disc or one of the other ADR's has a group that helps individuals with insurance matters?

Don't give up!! Appeal with Aetna two get a two level procedure approved.
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  #6  
Old 07-12-2010, 05:14 PM
Lauren Lauren is offline
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Join Date: Dec 2009
Posts: 11
Default Are you still out there? Can you weigh in?

Hi - I hope you are all doing very well. You are the trend setters and I appreciate all you've done and shared about your process.
I'm 5 months out from surgery and on my 2nd appeal. I've been told that to win this, I will need a list of "precedents" set by other insurance companies - specifically, names, dates of surgery, physicians and insurance name. Would any of you be willing to share that information? I can provide a privacy statement signed by me for specific use of the information, if you so desire. There are so many of us struggling to get our surgeries paid for - it's high time that insurance companies move medicine ahead in the US by agreeing to pay for these life-affirming surgeries.
Once I get my insurance paid, my intention is to begin a campaign to get ADR multi - level recognized as a standard in American medicine. Anyone care to join me?
Looking forward to your replies -
Lauren
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Lauren
57yo Female Cervical stenosis with myelopathy
Fusion 2006 C5/6 to address worst of 4 levels
Fall 2009 return of symptoms
Jan 29 2010: 3 level ADR in Bogen Germany by Dr. Bertagnoli -C3/4, C4/5, C6/7 with hardware removal
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