Kaiser LP-ESP Advice

[l10ydchristmas]

Hello All - I am new to the community and would appreciate any insight you may have on potential Kaiser Permanente insurance approval of ADR in Germany.

Based on my research, I believe the LP-ESP from Spine Innovations is the most advanced disc prothesis on the market and that Dr. Bierstedt is a great potential surgeon for implanting this device.

I would appreciate any advice regarding proper steps to build a case for insurance approval. I realize there are many obstacles but would you recommend meeting with an in-network Kaiser surgeon? Is the the ideal outcome to have them indicate surgery is required but the most advanced technology is not approved in the U.S.? Should I be seeking an explicit recommendation for implanting the LP-ESP in Germany?

Thank you again. I would appreciate any insight you have.

[Cheryl0331]

Insurance usually only covers 50% out of network and will not cover the cost of a device that is not approved in the U.S. These devices are about $5000 each. So even if you get approved, you are out at least the cost of the implant, plus the 50%. Some insurance will assess a 10% penalty for not being preauthorized.
Surgical necessity is the first thing.
They may also ask for any other conservative treatments you have tried.

[l10ydchristmas]

Thank you Cheryl. Would you advise meeting with an in-network spine surgeon to document medical necessity and then filing a case with Kaiser for out of network approval for the surgery?

Also, if you would like to share, very interested to hear how you are feeling after having the CP - ESP implanted.