ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

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.

Thread Tools
Old 04-22-2008, 01:45 PM
CindyLou's Avatar
CindyLou CindyLou is offline
Senior Member
Join Date: Mar 2007
Posts: 627

LBP, I ditto Terry. One day at a time. Focus on your recovery first. And big congratulations on making it to the other side! It is a long time coming and well-deserved, that's for sure. Keep us posted by and by.
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!!
Reply With Quote
Old 04-23-2008, 03:26 PM
phylly phylly is offline
Senior Member
Join Date: Dec 2007
Posts: 342

More congratulations! Take it easy, it is a painful recovery and you are just starting but you should feel better soon. Please let us know how you are doing.
Cervical fusion C4-C6 2002
Fall on tailbone April 2005
Discogram concordant at L4-S1 2007 for back pain not leg pain
Prodisc ADR surgery L4-L5-S1 November 2007
Decompression surgery L4-S1 for left sided sciatica July 2008
Continued back and leg pain, looking at possible fusion
Removal of Prodiscs and L4-S1 fusion February 2009
Reply With Quote
Old 04-23-2008, 05:25 PM
Liz Liz is offline
Senior Member
Join Date: Oct 2007
Posts: 195

congrats LBP! your perseverance is very inspiring to people, but it shouldn't have had to be that way. US healthcare infuriates me.

hang in there... i had a difficult surgery too. i can't imagine those that wake up "pain free" especially with 2 keeled ADRs. how much did you grow? i grew an inch and that hurts in ways no one can explain until you feel it yourself. you become so aware of how everything in your body is connected after ADR surgery. you can also separate muscle, disc, bone, nerve, facet, ligament, SI pain. i wish i was not part of this elite group of company!

if you're still struggling next week i'd recommend "borrowing" a pillow from the hotel if you don't have an extra. i'd also recommend reserving a wheelchair at the airport to get you from the curb to the gate which can be a very long walk (but then walk on the plane)... also will let you bypass security line. you can then sit on the pillow in the wheelchair and use it on the plane. i rec pressure against your incision on take off/landing.

i hope your pain levels start to drop soon.

scoliosis; 1998 snowboarding injury->DDD L3-S1 w/annular tears/protrusions; 2007 episodes of rt foot drop
2007 Prodisc ADR L4-S1
L4-5 Prodisc tilted/facet issues; old L5 nerve damage
2009 L4-5 Prodisc ADR removed and revised to XLIF w/posterior instrumentation
massive hemorrhage from tear of inferior vena cava at right iliac vein due to adhesion from Prodisc op
2010 not fused; as a result of complications permanent nerve damage to lumbar plexus causing severe rt leg, hip, groin pain
Reply With Quote
Old 04-23-2008, 10:33 PM
LBP LBP is offline
Senior Member
Join Date: Aug 2005
Posts: 446

Hi Liz,
Good ideas. I have called the airline and asked for wheelchair assistance. I will be taking my walker on the plane as far as they let me. I do have a pillow from home with me. I wasn't going to bring it on the plane but now I think I will!

I cant remember how much my surgeon said I grew but I told him that I was experiencing very stong painful growing pains in the hip flexor thigh area in addition to the constant sciatic numbness up and down my left leg/foot. It's improving ever so slightly.

The surgeon said he had one patient surfing 10 days after surgery! I couldn't imagine that! Just walking a few blocks 4-5 times a days is exhausting for me.

All in all I am staying postive and feel good about the recovery even though it's difficult. I do feel like these issues will resolve. I've wanted this surgery so bad for so long and my surgeon stresses giving it 6 weeks before considering a pain management physician, so that's what I'll do.
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
Reply With Quote
Old 04-24-2008, 05:37 AM
Terry's Avatar
Terry Terry is offline
Senior Member
Join Date: Oct 2006
Posts: 1,210


You just had major butt kicking surgery. I remember being exhausted and worn out very quickly and having to go back to the hotel room to sleep. I wanted so bad to see more of Germany as it is such a beautiful country. The primary thing is to take care of yourself and listen to your body. You are absolutely correct that these issues will resolve themselves. It just takes a little time.

Hang in there

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
Reply With Quote
Old 04-24-2008, 01:19 PM
chasswen chasswen is offline
Senior Member
Join Date: Apr 2006
Posts: 627

give your body at least 6 to 9 months. my leg and feet stuff are still improving 19 months out.
just hang in there listen to your body and let the force heel your body force (god)
at 6 weeks you should see improving and again at 6
then it slows abit but over time you will see it.
hugs chuck
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
Reply With Quote
Old 05-09-2008, 07:36 AM
eileen gallagher eileen gallagher is offline
Junior Member
Join Date: Nov 2007
Posts: 9

I also wanted to let you know that not everyone wakes up painfree, but don't fret. I had a 3 level ProDisc ADR (Bertagnoli/Oct 06) and my lower back pain was gone shortly after surgery, I still have some leg pain. My son had a 2 level ActivL surgery (Zeegers Jan 08). He was in great pain as soon as he woke up from the surgery. Even Dr. Zeegers said 'this is not usual'. However, my son could not bend at all before his surgery. He had not had any physical therapy and was like a board. He did have PT post surgery and one day he woke up and the pain was "gone". He went back to work in 2 months to the day. so there is hope. From speaking to patients and Drs there is an issue when the ligaments, tendons and muscles shrink due to DDD. When you stretch them during surgery, they can be very painful. I had extensive PT and something called Graston Technique. It involves stretching and releasing the above using instraments. I know several ADR patients that have used this to relieve the pain post surgery. I also recommend equipment based Pilates. Good Luck!!!!
Reply With Quote
Old 05-17-2008, 10:28 PM
LBP LBP is offline
Senior Member
Join Date: Aug 2005
Posts: 446

I am familiar with Graston tech and a big fan of pilates equip based exercise/stretching so that is what I hope to do when I'm allowed to start PT! That's what I hope will make the difference!
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
Reply With Quote
Old 07-11-2009, 06:47 PM
Deborah Deborah is offline
Join Date: Sep 2008
Posts: 78
Default Medicare paid hybrid

We have Medicare primary and a standard 'medigap' add-on insurance to pick up the difference (between % between what Medicare approves and total amount Medicare has approved). Hub is 42 years old and meets criteria for ADR; we discussed at length 2 level ADR v. hybrid, but decided hybrid made sense (jury still out on if there is a definite preferred for those 2 levels done together, in my opinion).

Hub had hybrid surgery March 3 - L4/L5 Prodisc and L5/S1 fusion. It was discussed at length with Medicare prior to surgery (Nov 12 - Jan 22) with myself, the doctor, CMS and the doctor/contractor for CMS. The doctor worked very hard proving it was necessary, but did win a tentative 'we would cover if done as described' decision.

We all still held our breath - the total bill was well into 6 figures. This week we got notification Medicare had paid, and the add-on paid the difference as required by law/contract (the amount paid was based on Medicare contract, which was the amount the hospital billed for all services).

It would have been impossible to do without the coverage, unless we sold our home. As it is, we cashed in most of savings to cover incidentals along the way. Surgery took place March 3, and hub is off meds (other than occasional muscle relaxant) for 2 weeks now. Prior to surgery he was on 60mg oxycontin 3xday plus break throughs; after surgery it was 20 mg methadone 2xday, within a week 10mg 2xday (plus dilaudid break throughs) and taper from there.

He's still quite weak and is just about to get into PT (he honestly hasn't been able to go regularly yet). He is able to putter around the house a bit most days and he's 'all there' mentally. We can have friends visit again, and life feels so much more normal, with his strength and abilities improving every day.

2 years prior to surgery he had hit the low of being basically bedridden - accident causing injury was in 2001 and he'd tried it all from minor surgeries to electro stim implant 2x, all kinds of meds, all kinds of PT. Tests in Sept 2008 (CT, MRI and discogram) all pointed to the problem being L4/L5 and L5/S1 with the rest looking healthy. All of this I would assume contributed to the approval. I have no doubt the results would be the same with someone of any age ... the age cutoff seems ridiculous.

I hope the information can help someone else!


C3-5 fused 2001
Hub: C3/4 fused 2001
Hub: TDR Prodisc L4/5, Fusion L5/S1 on 3/3/2009
Reply With Quote
Old 08-10-2009, 10:31 PM
Jack Jack is offline
Senior Member
Join Date: Jul 2009
Posts: 120

Am I right to assume that those of you with Medicare are 65 or older?
Reply With Quote


Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Similar Threads
Thread Thread Starter Forum Replies Last Post
Medicare Proposes No Coverage for Spinal Discs in over 60`s Alastair Insurance Hell 0 06-11-2007 01:39 PM
Medicare approval of coverage for Charite sahuaro The Big File 4 05-18-2006 03:34 PM
Medicare PT Cap cervie queen The Big File 1 12-06-2005 02:46 AM
Medicare-Medicaid Coverage on ADR (Reposted) Harrison The Big File 3 09-28-2005 09:17 PM

All times are GMT -4. The time now is 04:41 PM.

© Copyright 2006-2023 All rights reserved.