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  #1  
Old 07-05-2012, 08:53 PM
YZ2U YZ2U is offline
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Join Date: Jun 2012
Posts: 5
Default Approval by Veterans Health Administration...

YES!!! I just received information that my preauthorization request to have the Veterans Health Administration cover my Lumbar ADR procedure was approved. I wasn't sure if I would get approval because I read that the VA would not cover procedures to be done overseas and could find no one that had gotten approval domestically.

That said I'm only having ADR at 1 level (L4-L5) and my private insurer (Anthem BC of CA) denied me previously. I will continue to fight my insurance company with the hope that potentially winning approval will further push them to change their anti-Lumbar ARD policy.

Wish me luck!
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  #2  
Old 07-06-2012, 10:28 AM
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Harrison Harrison is offline
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Default

Good luck! Keep going!
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
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  #3  
Old 07-08-2012, 07:37 PM
Slackwater Slackwater is offline
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Quote:
Originally Posted by YZ2U View Post
YES!!! I just received information that my preauthorization request to have the Veterans Health Administration cover my Lumbar ADR procedure was approved. I wasn't sure if I would get approval because I read that the VA would not cover procedures to be done overseas and could find no one that had gotten approval domestically.

That said I'm only having ADR at 1 level (L4-L5) and my private insurer (Anthem BC of CA) denied me previously. I will continue to fight my insurance company with the hope that potentially winning approval will further push them to change their anti-Lumbar ARD policy.

Wish me luck!
Best wishes (luck) moving forward.

Anthem Blue Cross coverage position
SURG.00055 Artificial Intervertebral Discs

Anthem B/C Position Statement
Investigational and Not Medically Necessary:
Lumbar artificial intervertebral discs are considered investigational and not medically necessary.

Appeals may get you moved forward. The above text is from Anthem and it may or may not apply in California. I assume it applies.


VHA: I am fuzzy w/o research again. Dr. Schoenfeld, US Army in made a comment in Spine (Note 1). I recall an AAOS meeting with military orthopaedists, fuzzy.

Check your surgeon's experience, ask how many implants in a tasteful manner, etc. VHA

Charles Rosen, a surgeon working in the VHA system, questioned ADR / TDR design, trials, etc. To Dr. Rosen's credit, he wrote "Many of these failures have been described as surgical errors in either placement or sizing, surgical approach errors, inexperience, inappropriate indications, and patient non-compliance".
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  #4  
Old 07-09-2012, 12:39 AM
YZ2U YZ2U is offline
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Join Date: Jun 2012
Posts: 5
Default ...Clarification

The approval I received was for the VA to cover having the procedure done outside of the VA system by very experienced private physician that I've been seeing.
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  #5  
Old 07-09-2012, 09:18 PM
Slackwater Slackwater is offline
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Quote:
Originally Posted by YZ2U View Post
del.text
outside of the VA system by very experienced private physician that I've been seeing.
Thumbs up.
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  #6  
Old 07-25-2012, 12:25 PM
christinlal christinlal is offline
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Join Date: Nov 2010
Posts: 103
Default So

happy to see approval for adr.
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12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
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  #7  
Old 07-25-2012, 02:25 PM
2Confused 2Confused is offline
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Join Date: Jun 2011
Posts: 322
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Congrats! on your pre-approval!!!!
I'm still waiting, waiting, waiting!
Keep us posted!
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50 year old female
Rear-Ended in 2009
Disk rupture cervical 5-6 & 6-7
2 level M6 ADR, Dr. Clavel - Oct. 2012
Insurance paid
Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel
Post Op 2+ years
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