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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 03-26-2009, 08:39 PM
Deborah Deborah is offline
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For those who feel strongly 2 level TDR is what they need... remember FDA approval shouldn't be far off if you can wait (within one year). I agree totally with ans about considering hybrid; many doctors and some of us individuals actually find it preferable for L4-5 TDR and L5-S1 fusion. (It turned out in my husband's case that L4-5 could have a well seated and placed TDR, but the L5-S1 level skews just enough, which apparently isn't unusual, that a TDR wouldn't be perfectly aligned... not fully visible until exposed by surgery.) There's the consideration that for most people L5-S1 has very little movement naturally.

ans: You know you can make this happen. Get a few doctor consults from docs you trust and go for it... there's a lot of data out there now that makes hybrid a much more winnable fight. (I'll be glad to share the particular studies used to convince CMS, but I'd guess most docs can get a pre approval in their own way.) The biggest issue if docs consulted find you an 'appropriate candidate' given your specific back condition. For that, I'd see at least 2 docs you really have reason to trust.

Debi
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Deborah

C3-5 fused 2001
Hub: C3/4 fused 2001
Hub: TDR Prodisc L4/5, Fusion L5/S1 on 3/3/2009
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  #12  
Old 04-22-2009, 10:30 PM
ans ans is offline
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Thank you very much Debi. My best to hubby. - Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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  #13  
Old 04-23-2009, 12:42 AM
JaclynR JaclynR is offline
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Posts: 28
Smile Kaiser LA/Orange county DOES do ADR cervical and lumbar

Hello I am a patient of Kaiser also and just had a one level ADR L5/S1 PRODISC. I have my surgery in Baldwin Park at the spine center so I dont know if every county covers them or not. My surgeon was Dr. Tang, Chris. I also know they use different disc's for the replacements I just dont know all of them. I do know that the charite one was recalled by kaiser and they will no longer implant them for whatever reason they have. I also know that kaiser now has a lot of different coverage plans and depending on the plan patients have will determine hosptial co-pays, deductibles ect. So although kaiser does implant cervical and lumbar ADR at least in LA/Orange county Iam not 100% they cover everyone or every county or state. I hope this helps!
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Car accident 03' T-Boned on my driver side
Chiropractic, P.T 03'-06'
MRI Lumbar- 07' 8mm herniation L5/S1, DDD,spinal stenosis
2 Epidurals, 2 SI Joint injections, Facet Injections
Discogram 6/08' positive herniation and annular tear
IDET 8/08'- NO SUCCESS
Functional Discogram 1/09' positive for pain in only that disc L5/S1
Lumbar x-ray 2/09- severe DDD
PRODISC ADR L5/S1 4/09- over 80% improved!!
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  #14  
Old 04-30-2009, 05:44 AM
ans ans is offline
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Thank you J. Best of luck to you. - Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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  #15  
Old 05-01-2009, 04:02 AM
JaclynR JaclynR is offline
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Join Date: Apr 2009
Posts: 28
Smile Thank you!!

Thank you ANS. I had a great experiance with kaiser, If anyone has any questions, Iam more than happy to answer them..
__________________
Car accident 03' T-Boned on my driver side
Chiropractic, P.T 03'-06'
MRI Lumbar- 07' 8mm herniation L5/S1, DDD,spinal stenosis
2 Epidurals, 2 SI Joint injections, Facet Injections
Discogram 6/08' positive herniation and annular tear
IDET 8/08'- NO SUCCESS
Functional Discogram 1/09' positive for pain in only that disc L5/S1
Lumbar x-ray 2/09- severe DDD
PRODISC ADR L5/S1 4/09- over 80% improved!!
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  #16  
Old 05-02-2009, 01:45 PM
Adrienne Adrienne is offline
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I don't know where you are but I do know that Kaiser Oakland does them. They would have done mine but for my slightly arthritic facet joints and suggested a fusion instead which I ended up doing at Stanford.
The surgeon seemed very knowledgeable and spent an over an hour with us. I'm blocking on the the surgeon's name but it started with a G. Gorek?
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Minimal DDD L4/L5
Minimal DDD L5/S1
Disco 4/07 : Large tear: @L5/S1
Idet 4/08 No improvement
Now looking at ADR vs. Fusion
ALIF Fusion 2/10 Stanford
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  #17  
Old 05-21-2009, 09:31 PM
ans ans is offline
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Dear Kaiser Members,

J: I'm amazed that they approved a ProDisc at this level. I hope that you are faring well.

Duh, was your surgeon well-trained in ADRs or different fusion techniques?

Does a member have a choice of surgeons at all? I'm a bit leery b/c I've been told that there's little choice w/Kaiser.

Appreciate your time. Best - Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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