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  #1  
Old 11-27-2018, 04:02 PM
leipan71 leipan71 is offline
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Join Date: Nov 2018
Posts: 38
Default Hi from a new member

Hi, everyone, I am so excited to find this online forum. My name is Lei and I have a history of 30 years of lower back pain with DDD, and now I have two bulging discs and annular tear at both L4-L5 and L5-S1. I have tried many non surgical ways for healing. Now at the age of 47 and lying down most of the time on couch to avoid pain, I am coming to the point of finding a doctor who can fix my back surgically.


I had a consultation with Dr Guyer at Texas Back Institute last Tuesday. He told me that I need a two level ADR. He says that it costs around $50,000 because my insurance Aetna won't pay for it. He also says that if money is the issue, I can do fusion at L5-S1 and one ADR at L4-L5 and it will cost the half.


I have read lots of reviews about Dr. Bertagnoli online but can hardly find many reviews about Dr. Guyer in the field of ADR. I wonder whether anyone here has done surgery with him and how does it work for you?


Thank you so much!
__________________
started to have back pain at age of 18
DDD at L5-S1 at age of 23 in 1993
bulding discs and disc tear at L4-L5 and L5-S1 in 2017
DiscSeel procedure at L3-S1 in Feb 2018 (no help)
considering ADR at L4-L5 and L5-S1
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  #2  
Old 11-27-2018, 08:40 PM
GravyBaby's Avatar
GravyBaby GravyBaby is offline
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Join Date: Mar 2018
Posts: 128
Default

Hi Lei! Welcome to the forum! I am sorry to hear about your back pain.

I dont know much about Dr. Guyer other than he is an associate of Dr. Blumenthal. Is there any reason you didn't consult directly with Dr. Blumenthal? I called and requested him specifically, I'm sure you can do the same if it would make you feel more comfortable.

I got the green light with him, but decided to go with the co-inventor of the latest FDA-approved lumbar prosthetic, Dr. Rolando Garcia.

If I were you, I would do everything I could to not have L5-S1 fused. It's basically the junction between your upper and lower body. It will restrict you more than any other lumbar level fusion and increase pressure on all your surrounding joints.

As far as your insurance, Aetna is a pretty big carrier. You may be able to submit for reimbursement if you end up having to pay for the surgery yourself. The dual-level is a little bit tricky though. Insurance companies in the US are dragging their feet as hard as they can to not pay for them. Realistically you may not get it covered or reimbursed.

But this is America and you can always fight them and sue them to change the legal precedent because it's a load of malarchy they're not covering these kinds of surgeries in the first place. You could change the world for others in your situation. But that costs lots of money and comes with the risk of losing to a huge corporation with access to lots of high-powered lawyers.

In any case, I wish you the best of luck on your search and journey!
__________________
2001 - Pulled off monkey bars, landed directly on coccyx.
2006 - Sports injury that made it worse.
2016 - Multiple instances of paralyzing low-back pain.
2017 - Blew out my back on leg-press. MRI showed L5-S-1 disc herniation and grade 1 retrolisthesis.
2018 - Successful ADR surgery with Dr. Rolando Garcia using the Activ-L implant.
2019 - In physical therapy for burning in feet, L4-L5 diffuse disc bulge and SI joint pain.

29 - Male - American
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  #3  
Old 11-27-2018, 08:56 PM
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Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 6,866
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Welcome Leipan.

There have been instances where a one level fusion and one ADR have been reimbursed. Texas Back has a great deal of experience in these insurance areas and you should be able to speak with an insurance specialist there. You will have a far better chance of reimbursement there, or other higher volume clinic in the US than outside the US.

Though I generally for ADR, I also know many patients that have had lumbar fusions and have done will in the long term.

BTW, Guyer and Blumenthal are a few of the most experienced ADR spinal surgeons in the country. You would be in good hands with either IMHO.
__________________
"Harrison" - info (at) adrsupport.org
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
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #4  
Old 11-28-2018, 10:22 AM
leipan71 leipan71 is offline
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Join Date: Nov 2018
Posts: 38
Default ADR with Dr. Guyer

Thank you so much for your input. DR Guyer told me that if I do L5-S1 fusion, L4-L5 ADR, The insurance company will pay for the fusion part, which cuts the cost from $50,000 to $25000. BUt he says that if we can come up with the money, he suggests two level ADR if he was the patient. So at this moment, we would like to go with two level as he sugguested. It is good to hear that DR Guyer is very competent, that is the impression I got with just meeting with him once. My insurance covers DR Blumenthal as well. So maybe I can have a consultation with him too to have a second opinion.


At first, I was considering going to Dr. Bertagnoli since his name is out there, but after reading the posting here, I realize that if I can find a competent doctor in the US, it would be much easier for post-op care or if there is a chance of revision. As far as the cost, $50,000 for two levels at TBI is probably not outrageous comparing to DR. B.


I got comprehensive and scared after reading the revision stories, but try to remember to be positive and hopeful.
__________________
started to have back pain at age of 18
DDD at L5-S1 at age of 23 in 1993
bulding discs and disc tear at L4-L5 and L5-S1 in 2017
DiscSeel procedure at L3-S1 in Feb 2018 (no help)
considering ADR at L4-L5 and L5-S1
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  #5  
Old 11-28-2018, 12:05 PM
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Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 6,866
Exclamation

Leipan, your post makes sense to me. But don't forget to connect with their reimbursement specialist(s)! These appeals take time.
__________________
"Harrison" - info (at) adrsupport.org
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
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #6  
Old 11-28-2018, 01:21 PM
leipan71 leipan71 is offline
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Join Date: Nov 2018
Posts: 38
Default ADR with Dr Guyer at TBI

Do you mean that if I pay $50,000 for the procedure out of pocket, I can still try to get the appeal going with the insurance company? You mean the reimburse department at TBI might help me with that process?


Thank you so much for your suggestion.


Lei
__________________
started to have back pain at age of 18
DDD at L5-S1 at age of 23 in 1993
bulding discs and disc tear at L4-L5 and L5-S1 in 2017
DiscSeel procedure at L3-S1 in Feb 2018 (no help)
considering ADR at L4-L5 and L5-S1
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  #7  
Old 11-28-2018, 01:25 PM
leipan71 leipan71 is offline
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Join Date: Nov 2018
Posts: 38
Default ADR with Dr. GUyer

I forgot to ask about the cost of revision. According to your experience, if there is anything wrong after the ADR surgery, and a revision need to be done such as a fusion. Would the insurance company cover or I have to pay out of pocket again? How about the post-op PT stuff? I saw other people posting doing PT after surgery, would insurance cover that even if they don't cover the surgery itself?
__________________
started to have back pain at age of 18
DDD at L5-S1 at age of 23 in 1993
bulding discs and disc tear at L4-L5 and L5-S1 in 2017
DiscSeel procedure at L3-S1 in Feb 2018 (no help)
considering ADR at L4-L5 and L5-S1
Reply With Quote
  #8  
Old 11-28-2018, 06:24 PM
GravyBaby's Avatar
GravyBaby GravyBaby is offline
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Join Date: Mar 2018
Posts: 128
Default

Those are all very good questions. Yes, you can still appeal even if they completely deny the procedure. As Harrison mentioned, get the ball rolling immediate because the entire process can take months, and speak with the reimbursement specialists at TBI. You dont have to wait until you get the surgery to do this.

I'm sure Dr. Guyer is stellar, but if it were me, I would want to go with the absolute best. Do you know if it would be any more expensive to go with Dr. Blumenthal?

In my case, I am in the first step of the appeal process. I will be starting PT this week and as far as I know, it will be covered. Not sure about the other stuff.
__________________
2001 - Pulled off monkey bars, landed directly on coccyx.
2006 - Sports injury that made it worse.
2016 - Multiple instances of paralyzing low-back pain.
2017 - Blew out my back on leg-press. MRI showed L5-S-1 disc herniation and grade 1 retrolisthesis.
2018 - Successful ADR surgery with Dr. Rolando Garcia using the Activ-L implant.
2019 - In physical therapy for burning in feet, L4-L5 diffuse disc bulge and SI joint pain.

29 - Male - American
Reply With Quote
  #9  
Old 11-28-2018, 11:02 PM
leipan71 leipan71 is offline
Member
 
Join Date: Nov 2018
Posts: 38
Default ADR with Dr Guyer

Thanks so much for the advice. I wonder whether you paid in advance for the entire surgery in one payment before the surgery ? The way I was told sounds like I need to pay in advance the entire amount.


I have no idea whether Dr. Blumenthal is more expensive or not. I visited Dr Guyer for the first time only one week ago and I am still trying to process the idea of having an ADR surgery soon. He is the first surgeon I have ever visited. Does Dr Blumenthal do more ADR than Dr. Guyer? How can one tell that which one is better? (sorry, I am so new in this area.) Mine is a two level, maybe the actual number of cases the doctor has done counts? If yes, where can you find the info?
__________________
started to have back pain at age of 18
DDD at L5-S1 at age of 23 in 1993
bulding discs and disc tear at L4-L5 and L5-S1 in 2017
DiscSeel procedure at L3-S1 in Feb 2018 (no help)
considering ADR at L4-L5 and L5-S1
Reply With Quote
  #10  
Old 11-30-2018, 01:44 AM
GravyBaby's Avatar
GravyBaby GravyBaby is offline
Senior Member
 
Join Date: Mar 2018
Posts: 128
Default

You're welcome, I am happy to help.

It is hard to answer these specific questions. When I asked my doctor, he didn't even know himself how many he has performed. I got him to answer in a ballpark range eventually. It turned out to be in the 700 range.

I didn't have to pay for my entire surgery fortunately, but the portion I did have to paid did need to be paid in full before the surgery or the surgeon would not schedule it. I imagine if your insurance company is not going to cover it, you will need to pay in full.

Now, you have more options here. Most of the people on this forum who opt for lumbar disc replacement and have to pay for it themselves go to Europe because it is cheaper. You will not have the same legal protection as here in the states and it may prove more difficult to fight for an appeal, but it could save you a bundle.

If you are interested, I would recommend Dr. Pablo Clavel in Barcelona as a good place to start if you are interested in a multi-level abroad. He is among the more affordable and more experienced.

If you are still interested state-side, you may want to do some more reading on Dr. Blumenthal and why he may be your best choice. Just Google him. If he is local for you, even better, because he is probably the best in the region.
__________________
2001 - Pulled off monkey bars, landed directly on coccyx.
2006 - Sports injury that made it worse.
2016 - Multiple instances of paralyzing low-back pain.
2017 - Blew out my back on leg-press. MRI showed L5-S-1 disc herniation and grade 1 retrolisthesis.
2018 - Successful ADR surgery with Dr. Rolando Garcia using the Activ-L implant.
2019 - In physical therapy for burning in feet, L4-L5 diffuse disc bulge and SI joint pain.

29 - Male - American
Reply With Quote
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