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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 01-25-2007, 12:30 PM
Bailey Bailey is offline
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Join Date: Nov 2006
Posts: 56
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Greetings!
I finally got the news I was looking for. As most know, been waiting news regarding 2 level Prodisc replacement. AETNA has approved it and now I'm set with a surgery date of 2/19 at TBI. And to top it off, I've called Aetna to confirm, but they are saying that they will pay for 2 level! Being the eternal pessimist I am, am reading the fine print about copays, coinsurance, payment procedures, etc. and expect that a hefty sum will still come out of my pocket, but so far so good! So for those out there who have been arguing and arguing with insurance companies, there is hope. Aetna rep told me, when I asked about 1 level vs 2, was that everyone is getting more educated now. That is great news! And maybe other carriers will follow.
I now look forward to reading up what others of you have recommended pre-surgery and post-surgery. Can't say that I'm excited about it all - though I would call it a true miracle that I'm in the situation that I am. Prayer does work! As everyone else, I'm scared about the procedure, the recovery, the chances that I will be worse off than I am now, etc...But we got to live right and I think I'm making strides at getting back my life again.
More updates later.
__________________
1995 L5 S1 laminectomy
2005 2 level herniation L3/L4 and L4/L5
5 epidruals
2006 discogram
2006 - diagnosed DDD - 2/19/07 2 level ADR- on the road to recovery!!
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  #2  
Old 01-25-2007, 06:50 PM
LBP LBP is offline
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Join Date: Aug 2005
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Congratulations Bailey!!!!!!!!
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #3  
Old 01-26-2007, 02:03 AM
Kim_Dean\'sWife Kim_Dean\'sWife is offline
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Join Date: Oct 2006
Posts: 108
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I am doing the biggest happy dance for you right now!!!! YAYYYYY!!!!!!!!
__________________
Wife of Dean, age 32.
Injured 12/05- snow shoveling.
Herniated Discs & DDD at
L4/5 & L5/S1.
-Chiropractic treatment
-3 Failed injections
-Orthopedic Massage
Prodisc Surgery on 2/22/07 Dr. Yue
Yale New Haven Hospital, CT
L4/L5 & L5/S1
Back
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  #4  
Old 01-26-2007, 08:38 AM
JFerg JFerg is offline
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Fantastic!!!!!!!!!!!!! After all the denials and communications, what was the silver bullet that closed the deal? I know you're cautiously optomistic. This process brings one to a new level of trust and faith. Ziglar or Blumenthat or does it matter? Congrats!!!!
__________________
DDD diagnosis - denied disc replacement by United Health Care 3x's - Recently, Manipulation Under Anesthesia procedure - much needed relief from constant pain.
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  #5  
Old 01-26-2007, 08:39 AM
Sharon Sharon is offline
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Join Date: Nov 2006
Posts: 51
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Hi Bailey,
Great news on your insurance approval. I had a long fight with my ins company too, it was bad enough dealing with the back pain, without having to worry about how the surgery was going to be paid for.
I can really feel for your apprehension, it is so scarey not knowing what to expect and how you are going to feel after surgery. I am now 3 weeks post op and although I still have back pain I am very optomistic it is going to settle down. I can honestly say nothing has been as bad as I thought it would be. I would definately recommend having some help the first couple of weeks. My parents have been staying with me, I don't know how I would have coped without them.
The hardest part for you is right now, just stay focused!!
I wish you all the best.
__________________
Sharon
DDD L5-S1 (complete annular tear)
2 epidurals / 1 facet injection 2004 with no relief
Positive discogram 2005 L5-S1
Positive 2nd discogram 12/06 with anaesthetic block
Facet nerve block 2006 negative
ADR surgery L5-S1 Charite Disc / Dr Bitan January2007
X- LIF L4-l5 October 2009
Fusion L5-S1 revision surgery to eliminate charite disc. 2011
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  #6  
Old 01-26-2007, 01:10 PM
Bailey Bailey is offline
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Join Date: Nov 2006
Posts: 56
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Thanks everyone for the well wishes everyone!
JFerg, Zigler is doing it. I've been with seeing him for several years and with his experience in the FDA Prodisc Trials, I feel pretty comfortable. TBI is a great facility and I trust them. The silver bullet for me was that our company moved from UHC to Aetna on January 1. We presented my data to them and they approved. It was nothing short of a miracle and perfect timing as I'm experiencing another "flare" up this week. Sharon - what type of disc do you go with? Hope you continue to improve. I only hope I'm nearly as positive as you are at 3 weeks. My folks are coming in as well to help my wife and kids and ME, of course!
__________________
1995 L5 S1 laminectomy
2005 2 level herniation L3/L4 and L4/L5
5 epidruals
2006 discogram
2006 - diagnosed DDD - 2/19/07 2 level ADR- on the road to recovery!!
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  #7  
Old 01-26-2007, 01:15 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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seeking single male with aetna between 25 and 50
LOL LOL LOL LOL LOL

on a more serious note...anyone have info or know how to get a list of companies that offer aetna by city? I tried calling aetna today..they were dumbfounded by my question and couldn't get past the operator. I'm tempted to start calling insurance brokers...just have to find them first!
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #8  
Old 01-26-2007, 02:26 PM
JFerg JFerg is offline
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Join Date: Apr 2006
Posts: 52
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LPB - that's great stuff!!! i needed a laugh today. Just finished up another week of 150 8th graders and there were some bad ones today. I'm about as emotionally spent as ever. Isn't this a crazy world! Bailey's insurance changes overnight and it's hope for him and not the usual desperation and hopelessness. How has it gotten to this point? A procedure that's FDA approved, researched, tested, has a history to follow and yet the decision makers sitting in boardrooms with lawyers and dr.'s on payroll just won't let go of the purse strings. And, we, here, just go on in our daily lives somewhat disabled by pain and live in fear of the frequent level 8-9 flare ups that knock us out for 3-4 days at a time. We have to beg for a procedure that we aren't really sure is the answer but all our research points that way. And then overnight one of us gets a break and a more liberal group of decision makers decides to err on the side of a more humane approach to pain and disability. God bless you, Bailey. I (for what's it's worth) think you in the right place,Texas Back Institute. You're with the right man, Zigler. Plenty of experience to rest your nerves. And you get a chance at relief, renewal. I hope it all works out for you as it has for others on this forum. All the best to you, and I know a positive outcome on this is most likely going to renew your family once again, too. Because this problem, for me anyway, has taken a big toll on my loved ones. God bless you, Bailey.
__________________
DDD diagnosis - denied disc replacement by United Health Care 3x's - Recently, Manipulation Under Anesthesia procedure - much needed relief from constant pain.
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  #9  
Old 01-28-2007, 01:46 PM
Sharon Sharon is offline
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Join Date: Nov 2006
Posts: 51
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Hi Bailey,
To answer yor question I had the Charite Disc. Having your wife and parents with you will really help you out. I am now 3 weeks post op and feel comfortable that I will now be going solo during the day, my parents are flying home tonight. Don't forget to stay focused, you must not let fear get the best of you!!!!!!
__________________
Sharon
DDD L5-S1 (complete annular tear)
2 epidurals / 1 facet injection 2004 with no relief
Positive discogram 2005 L5-S1
Positive 2nd discogram 12/06 with anaesthetic block
Facet nerve block 2006 negative
ADR surgery L5-S1 Charite Disc / Dr Bitan January2007
X- LIF L4-l5 October 2009
Fusion L5-S1 revision surgery to eliminate charite disc. 2011
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  #10  
Old 01-30-2007, 09:48 AM
Eddie_G's Avatar
Eddie_G Eddie_G is offline
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Join Date: Apr 2005
Posts: 238
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Good for you! The more the merrier I always say!
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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