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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  
Old 09-20-2011, 05:51 PM
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laid up doc laid up doc is offline
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Dr Coric is quite highly regarded as an ADR surgeon, and I can vouch for him being easy to talk to and whatnot. Unfortunately, he can't help me b/c of the legal issue, and I'm not comfortable getting a Prodisc (that's the control in the study).

Good luck to you. I'm just 3 yrs older than you so I know how much this whole **** sucks at this age. You go to PT/clinic and most people are over 50 or so.

My whole life has basically been put on hold - I'm single and have more student and personal debt than most people have for a mortgage. I do, however, have quite a life and profession to return to WHEN I'm better.
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US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #12  
Old 09-20-2011, 10:17 PM
gymnast1981 gymnast1981 is offline
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Doc,
The doctor you suggested was the office that my husband emailed to get info, and they were notified that the trial is full and they are not excepting patients anymore.
on the website you gave me there are a bunch of email address so my husband is going to be making a bunch of emails tomorrow to see if there is a state taking patients..

do you know anything about trials? like do i have to pay for anything? like hospital stay, doctor fees, other things or is it all paid for? I'm new to all this so i have no idea.
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #13  
Old 09-21-2011, 01:16 AM
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hm that's weird bc they were trying to recruit me not 3 weeks ago.

i don't know a lot about what is or isn't covered in trials - my specialty/place of work does very very few true clinical trials because of issues with informed consent. the research nurse or whomever does the initial screening for a trial would be the person to ask.

i would say medical costs and followup yes, travel probably not beyond a certain amount if any. but, i really don't know. i've never been part of a randomized control trial, nor conducted one.

i would say that emailing all of the people on that list would be the best way to go. i [I]think that the Freedom trial is the only active lumbar ADR trial in the US.

given that your level of involvement is L4/5, i would be pretty persistent about ADR. don't know your financial situation, but 1 level ADR with Boeree or Clavel is about $30k plus airfare/food/incidentals.

my medical situation is a little less clear since it's L5/S1 - not very mobile typically so not as bad to fuse. still working on M6-L vs minimally invasive TLIF decision.

though, i have the flexibility of a gymnast even w/ back trouble, so mine is probably hypermobile. my sport is swimming - where flexibility is a plus as well, but in a different way. i was too tall in 6th grade to be a gymnast - my adult ht is 5'8".
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #14  
Old 09-21-2011, 11:35 AM
gymnast1981 gymnast1981 is offline
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thanks... i want to make sure i have a backup plan if my 2nd appeal is denied. but the clinical trials are at least giving me a little hope
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #15  
Old 09-29-2011, 03:20 PM
gymnast1981 gymnast1981 is offline
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Default Clinical Trials

has anyone ever been apart of a Clinical trial? im looking into it just in case my second appeal gets denied.

Freedom disc has been closed but one of the clinics that are doing the trial for Freedom gave my husband another trial to look into... anyone have any info on this one? here is the website...



http://clinicaltrials.gov/ct2/show/NCT00927238
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #16  
Old 09-29-2011, 05:03 PM
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laid up doc laid up doc is offline
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i think that since your level of involvement is L4/5, you'd qualify and it would be a reasonable try. the only thing is, the control is fusion, not a different disc.

the freedom trial was freedom vs prodisc. this one is nuvasive XL TDR vs fusion.
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #17  
Old 09-29-2011, 06:26 PM
gymnast1981 gymnast1981 is offline
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They got back to me and it seems that it would NOT be fusion!!!!! she stated that there is no control arm

so the way it sounds is that everyone in the study would be receiving the disc but then again i could be wrong

but my issue now is... that we would not be able to get pregnant for 5 years after the surgery which is a big concern to me considering i really really really really want to have a baby but then again whats another 5 years if i can get ADR and not have to do fusion!

decisions... decisions...

someone want to make the decision for me???? please!!!!!!!
__________________
Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #18  
Old 09-29-2011, 09:21 PM
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laid up doc laid up doc is offline
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Posts: 775
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a clinical trial inherently has a control arm, and the patients have to be randomized to exclude bias as to who they would "pick" to get fusion vs this new adr.

i would double check about this.

and yes - from what i've seen, most studies will tell you not to get pregnant for x number of yrs. 5 is on the high end.
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
Reply With Quote
  #19  
Old 11-02-2011, 05:55 PM
gymnast1981 gymnast1981 is offline
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Default Omg

UHC HAS BEEN OVERRULED!

i just got a letter in the mail today from UHC stating that my claim for ADR has been APPROVED!!!!!!!!!!!
__________________
Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #20  
Old 11-02-2011, 11:12 PM
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jss jss is offline
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Quote:
Originally Posted by gymnast1981 View Post
UHC HAS BEEN OVERRULED!

i just got a letter in the mail today from UHC stating that my claim for ADR has been APPROVED!!!!!!!!!!!
Becky,

CONGRATULATIONS!!!! I'm so happy for you! What is your next step?

Good luck, Jeff
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C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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