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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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  #21  
Old 03-21-2007, 09:18 PM
Abbe Abbe is offline
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Boy couldn't we all use some good news! I am on my second denial and if that weren't all I have decided to go back to Dr. Delamarter and stop going to Dr. Williams. I had asked Dr. Williams how many disc replacements he had done and he told me 15. That was too few in my mind. In addition his office never seems to get back to you so I had to make an appointment and go see him just to discuss being denied and what our next plan of attack should be. He had no idea that I had been denied the first time because he was never given my file to write to the insurance company. The gal who schedules the surgeries just sent in to the insurance co. and never got a letter of necessity from him. Then it was submitted incorrectly anyway. So, now that I am educating myself on this whole process I have found that Prodisc has an advocacy program for patients and they will work on your behalf to try and get the insurance company to approve the procedure. You can go onto Prodisc's web sight and get the phone number and contact them. They will need to be able to get your medical records so they can act as your agent so to speak but they have been very helpful and as with anything you have to be persistant. I did find out today that my insurance Co. asked for some more documentation so, I guess that this is better than another denial. My plan "C" is to use a version of the letter Paulette posted here and I am asking for the articles she mentions as well.

Abbe
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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  #22  
Old 03-22-2007, 08:44 PM
letteski letteski is offline
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CindyLou and Abbe

ProDisc Study Articles and more ADR Articles you can find on David's Blog under Study Articles.

Harrison any chance some of these can make there way to a special link on ADR Support so they can be found easyer by the community?

The best advice I can give you is to never give up and keep breaking the IC down. Please use any part of this letter you need. When it comes to dealing with Doctors offices don’t expect them to call you back, if you what to see them or have surgery with a particular doctor you have to foster all the communication. The office staff is under paid over worked and they don’t have an ounce of sympathy for you. Your just another phone call they have to deal with.

I hope this helps and don't hesitate to PM me anytime. Life is great and I'm here for you
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Paulette
ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005
L5-S1 DDD Diagnosis 12/04
T-12 Compression Fracture 10/04
C-7 Spines Process Fracture 5/99
http://prodisc2.blogspot.com/
You are my Rock God in you I can do anything
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  #23  
Old 03-23-2007, 06:08 AM
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CindyLou CindyLou is offline
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Paulette, thank-you for the information. I'd like to PM you with some questions but am not sure how to do it at the moment. I am a big skier as well, certified instructor, and one of my questions is: will I be ready to ski next January after having my adr (3 lumbar levels) in April? That's about a 9 month rehab time table. I stumbled on to your website and it makes me very hopeful, altho I know 3 levels is major. Did you have 1 level or more? Please, if you see this, maybe you could PM me with your email address. Thanks.
__________________
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!!
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  #24  
Old 03-23-2007, 08:00 AM
letteski letteski is offline
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Cindylou

I sent you a PM so look for it. So you can learn this function. Let me know if you can't figure it out I will check back.
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Paulette
ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005
L5-S1 DDD Diagnosis 12/04
T-12 Compression Fracture 10/04
C-7 Spines Process Fracture 5/99
http://prodisc2.blogspot.com/
You are my Rock God in you I can do anything
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  #25  
Old 03-23-2007, 08:17 AM
Abbe Abbe is offline
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Posts: 61
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Paulette,
I think you meant to PM Cindylou and somehow I got your PM.

Abbe
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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  #26  
Old 03-23-2007, 08:24 AM
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CindyLou CindyLou is offline
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Posts: 627
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Yes, I know how to receive the PM, just not send one! Not too tech savvy. But I did receive yours and thanks. I'm hoping and praying that when Dr. B gets in there, he will go, oh, not so bad, only 1 adr is needed. But that's not very realistic as my discogram was concordant pain 10/10 at L3-4, L4-5, L5-6 (my extra vertebra). This distraction pain is scaring the hell out of me. It's hard to think of being limited and in enough pain now, only to go into more extreme pain after surgery, and then to hear from some dumb *** that her adr didn't help at all. I did not need to hear that from her. I am at the end of my rope, yes, but I am diving into adr with all the hope in the world that this will help me! Sorry, I just had to rant/rave for a minute. Some people can be so stupid. I'm in really decent shape going into this, not overweight at all, eat right, still make myself get on treadmill with pain, so I'm hoping those factors will help with recovery. How long approx does the distraction pain go on? Or is it all over the board? That's enough rambling on my part. Off to the bank to wire the money for surgery. Thanks again! Cindy
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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!!
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  #27  
Old 03-23-2007, 11:28 AM
Abbe Abbe is offline
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Posts: 61
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Cindy Lou,

I think you meant this PM to go to Paulette. I have not had ADR done yet but it sounds like you and I have the same levels that have gone bad. I have L5, S1 partially sacralized. On all my previous MRI's that is how they classified it but on the most recent one the radiologist called it L6, S1. Partially sacralized means that it is partially fused to the sacrum yet partially free as though it were an extra vertebra and degenerating in the disc area. L4, L5 I have had a hemilaminectomy and discectomy and I am now bone on bone with virtually no disc left at all and what they call ostiophites which are bone growths from the vertebra going outward trying to compensate for the lack of disc. These growths and impinging on the nerve. At L3, L4 the disc is ruptured and torn. Back in 2004 Dr. Delamarter wanted me as part of the Prodisc trials and he was going to do a 2 level replacement but he was supposed to write to the FDA for a compassionate use waiver since I had already had back surgery. Well, I kept calling to see if it was sent and the person who was supposed to get that letter sent out left and another person took over. I kept calling back and no one would return my calls so I got lost in the shuffle. I also was not 100% sure I wanted to be in a study and thought I would wait for FDA approval.

I went to a neurosurgeon that my plan referred me to and he wanted to fuse L4, L5 and do a disc replacement at L3, L4 but then moved to Baltimore. So, Then I went to Dr. Williams and he is the one that wanted to do 2 fusions and a 1-disc replacement only because it is only FDA approved for one level. I am wondering how people are having multiple levels done here in the states. My guess is that they are paying out of pocket.

Abbe
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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  #28  
Old 03-23-2007, 04:56 PM
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Terry Terry is offline
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Join Date: Oct 2006
Posts: 1,210
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CindyLou:

Like you, I have been very athletic even before I went to Germany for my surgery. I had bicycled near 2,000 miles and did an incredible amount of walking pre-surgery. I went in to surgery at 163 lbs and 10% body fat. The better condition you are in the better your surgery and recovery is going to go.

I had 4 level ADR and was very compressed and re-gained 1" height out of the deal and have had a lot of distraction pain. I am on Lyrica 400 mg per day to deal with nerve pain and would still go through it again in a heart beat. I am much different today than before surgery where I walked with a cane and was bent low to the ground pre-surgery. I stand upright and my posture is amazing today.

I do not know how long I am going to have to deal with the distraction pain but am eager to be on my bicycle and am scheduled for my first ride of the season tomorrow.

Trust God, the homework you have done before surgery, and the care givers there and at home afterwards. You'll remember the pain pre-surgery and realize that you can live with the aftermath as long as the surgeon does a good job. You're heading to a good place and all of the worrying will not make it any better.

Take 5 deep breaths and call us in the morning.

Terry Newton
__________________
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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  #29  
Old 03-23-2007, 09:38 PM
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CindyLou CindyLou is offline
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Posts: 627
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Thank-you Terry. I needed to hear that.
__________________
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!!
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  #30  
Old 03-27-2007, 08:09 AM
desert brat desert brat is offline
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Join Date: Mar 2007
Posts: 8
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Paulette,
Thank you for sharing. I just postphoned my c5-6 & c6-7 cos my Dr wants to do anterior fusion instead of adr only cos the ins won't cover it. I am in the Atlanta Ga area. Ihave been reading & looking everywhere for more info on Dr. that will do this surgery as well as can help me with insurance.so far no luck.I am to the point I just may go ahead & get fused just for some releif.Is there anyway I can also get copies of those articles? Again THANK YOU SO MUCH & May God Bless. DesertBrat
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