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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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Old 07-27-2005, 01:41 PM
rickz68 rickz68 is offline
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Join Date: Jun 2005
Posts: 20
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All,

First, I wanted to thank everyone for posting on this site. It is a great source of info as well as a good anxiety relief knowing that most of the questions I have can be answered via the posts on this site.

I haven't posted much on this site so I want to take this time to tell you a little about my story/saga.

I've had back pain since I was about 18. I think it's a result of a fall down some concrete steps in the Chicago winter when I was about 15. Since then I remained very active palying all sports and the pain would come and go. I mostly ignored it. Then in '99 I was playing some basketball and my back just went out. My feet felt like they were concrete blocks. The next two weeks were pretty much terrible. Since then I have been in a lot pain and have tried every posible therapy I learned about including VAX-D, chiro, massage and 7 epidurals.

Anyway, I learned about ADR in '01 thru Dr. Lytton Williams at USC University hospital. He wanted to perform a fusion. I decided to hold out for something better.

I started fighting for the ADR surgery in March '04. At the time the procedure was experimental and I was immediately denied. Immediately after FDA approval I had my surgeon, Dr. Regan, resubmit. I was again denied. I decide to wait several months and resubmit. Each time I was denied I would appeal and get denied again. I then would go thru an IMR and get denied again. I was adamant that I should not have to pay for a proven FDA approved procedure. I decided to wait for the procedure to gain some momentum and in July of this year I once again had Dr. Regan's office submit for the surgery. I was denied. This time I wrote a more precise, fact based and filled, two page letter inquiring how they could deny me as well as requesting a detailed review process with a spine specialist. (I have to mention that I have to thank John Argiro at DePuy spine. He has helped me thru this process with advice and info.) To my surprise, two weeks after they received my letter, I received a call from Health Net stating that the denial was overturned on the basis of a specialty match review. In all I was denied by Health Net 5 times and by the Dept of Managed Health Care twice in the span of almost 1 year and 5 months.

I must say I still don't believe they approved my surgery. I think I am the first person that Health Net has approved. The doctor's office doesn't believe it either. But we are moving forward. I have a scheduled surgery date of Sept 13. I am a little scared but have fought too hard to stop now.

Once again I want to thank everyone for posting.
__________________
Pain since age 18.
DDD L5/S1
Health Net approval July 19, 2005
Charite w/Dr. Regan - Sept 13, 2005
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  #2  
Old 07-27-2005, 03:25 PM
djscal djscal is offline
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Join Date: Apr 2005
Posts: 232
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Rick, buddy! You've been through so much with Health Net, I am so happy for you. I'm going in next Tuesday morning with Dr. Regan and I'll let you know how it goes. We need to get together in a few months and compare notes when we're better.

Congratulations!

Dan
__________________
Age 34
DDD L5-S1, bulge and Grade V annular tear.
SED 2/15/05 - no luck
Charite @ L5-S1 8/2/05 with Dr. Regan
Struggling with facet joint pain.
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  #3  
Old 07-27-2005, 03:50 PM
Laura C Laura C is offline
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Join Date: Jul 2005
Posts: 86
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Rick,

That is great news. I am very happy for you. I commend you for your tenacity!!! I am also a patient of Dr. Regan. My surgery date is October 11th. I was already denied by BC but with another doctor. Dr. Regan's office just submitted a new request. If they deny that one, I am going to do exactly what you did. Did you suggest and contact John Argiro yourself? My case is a bit complicated - I need a fusion at L5-S1 because of an abnormality of the facet joint and then 2 level ADR above that . I have no other choice - refer to link below to see xray and ct. I would appreciate any info on your letter that you would be willing to give.

Once again congratulations on your victory! Don't worry, you will be on the road to recovery in no time and you are in EXCELLENT hands. Are you going to be at the new hospital? I heard that it is FAB!!!!
__________________
Laura

Missing Facet Joint L5-S1
Collapsed Disc L4-5
DDD L3-4
Severe Stenosis
Disco + 3 levels
Sched. Oct. 11 - 2 level ADR & fusion
Dr. John Regan - L.A.
Awaiting approval!
[URL=http://www.lauracedar.com/XrayGallery]www.lauracedar.com/XrayGallery[/U
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