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Old 07-07-2009, 11:23 AM
reddirt reddirt is offline
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Join Date: Jul 2009
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Default Strategies for arthroplasty coverage on Aetna Individual plan??


Long story short. Lumbar extension is *very* important to me b/c rock/alpine climbing & surfing (which requires a lot of extension when paddling out) are very integral parts of my life. I cannot imagine a life not being able to do these things. However, I have very little L45, L5S1 disc space left. I am 35 yrs old.

My employer based Aetna insurance ended end of April 30. My Aetna individual insurance began July 1 (no coverage for the 61 days in between) . Due to faulty answer from the sales rep, they dinged (increased my premium above the lowest rate) me for PT I had in January after a 12/23/08 L45 microdiscectomy.

I have established myself as a patient w/ an out of pocket family practice guy who is not my PCP so that any lumbar related pain mgt issues do not need to go thru Aetna. I definitely have DDD on my surgical report from 12/23/08. I can prolly get by on PT & pain meds for months, maybe years? but it's not an optimal treatment. While I am currently not in any rush to get arthroplasty immediately, it is an option I need to have available for the future.

If I do not do anything surgically via a clinical trial, I plan on laying low on the insurance radar w/r/t back issues until pain from DDD/arthritis is not adequately manageable.

Are there strategies/things to keep in mind/not disclose so that arthroplasty coverage might be possible in the future?


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