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| The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#21
02-02-2009, 03:30 PM
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Ok, another update. 2nd appeal denied. The reviewer, who claims to be a doctor, said that the surgery would be part of a clinical trial and therefore is experimental/investigational. What a cluebag. The prestige disc has been approved for nearly 1.5 years and they think because my Dr's notes show that we discussed the options of adr AND fusion that it MUST be part of a clinical study. He even stated that it was a fact. Guess it was too much trouble to pick up the phone and ask my Dr.
It would be funny if it wasn't so important to me to get the adr. The basic lack of understanding regarding the procedure astounds me. I've already filed a complaint today with my insurance company. Hopefully it will get some traction.
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DDD C5/6. Incorrectly diagnosed as tension headaches in September 1997. Nearly continuous headache since. Began having pain in wrists in 2000, believed it was onset of carpal tunnel. In 2005 pain began getting worse. Diagnosed as DDD in July 2007. Surgery recommended after 6weeks of PT made the pain worse. ADR scheduled for Jan 26, 2009. Rescheduled for August 5! Bryan disc finally FDA approved, and just in time too. Neck was all jacked up and had to be fused unfortunately. 
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#22
02-03-2009, 08:23 AM
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Jason,
My wife was given verbal approval for either fusion or ADR. She has BCBS but is also on my Aetna policy. I'm not sure how they're splitting the bill but it sounded to me like an approval. She's opted for fusion on the 26th. Bob
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04/06 L5/S1 Rupture 05/06 MRI shows DDD @ L2-S1 06/06 Diskectomy/ Laminotomy L5/S1 04/07 Recurrent Disc L5/S1 4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later: 03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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#23
02-03-2009, 01:52 PM
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I wouldn't count on a verbal approval, get it in writing.
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Cathy MRI 12/07 L4-5 Mild-moderate disc degeneration with dessication. L5-S1 Mild disc degeneration with dessication, minimal disc bulging. PT/medication/acupuncture/ESI's/facet injection Discogram 12/3/08 confirmed L4/L5 & L5/S1 as pain generators.
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#24
02-16-2009, 08:13 PM
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Another update
I called my doc's nurse again this morning to see if they had heard anything. She called back just as I was leaving work with some hopefully good news.
After the first appeal denial and asked my HR department if they could assist with the insurance company as we're self insured. They agreed to ask some questions, especially wanting information on why the specific procedure was denied since it was FDA approved, cost about the same, and was preferred by both myself and my Dr. I made sure my HR rep was informed of my opinions and beliefs on the reasoning of the insurance company for denial. The insurance company kept denying based on either long term safety and efficacy or by claiming it was investigational.experimental. The last denial even claimed that I HAD to be part of clinical study. The Dr's liaison with the insurance companies called my insurance company today to get an update and was told by the insurance company rep that my company had gotten involved and the denial would likely be overturned. Far from being written in stone but the nurse sure was excited. Hopefully I'll hear something in the next few days.
__________________
DDD C5/6. Incorrectly diagnosed as tension headaches in September 1997. Nearly continuous headache since. Began having pain in wrists in 2000, believed it was onset of carpal tunnel. In 2005 pain began getting worse. Diagnosed as DDD in July 2007. Surgery recommended after 6weeks of PT made the pain worse. ADR scheduled for Jan 26, 2009. Rescheduled for August 5! Bryan disc finally FDA approved, and just in time too. Neck was all jacked up and had to be fused unfortunately.
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#25
02-17-2009, 11:07 AM
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Good luck, I hope you are able to get your surgery soon. The waiting is so agonizing.
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Timeline: 1988:sprained neck roller skating 1989:dislocated neck in a freak accident 1993:MVA 1995:diagnosed with bulging disc C5/6 2000:disk herniated 2000-2004:multiple treatments including nerve root block, trigger point injections, epidural steroid injections, pt 2005-2008: pain meds and muscle relaxers only ProDisc-C replacement on c5/c6 11/18/08
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