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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.


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  #1  
Old 01-12-2009, 09:59 AM
cttom cttom is offline
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Default Only approval for one Disc! What to do?

I have recieved approval for one disc to be replaced. Do I wait for FDA? Should I get one done and get the other when FDA does approve? What is the cost for the Disc? In theory the hospital stay is paid for by insurance. I should only have to pay for the disc.



Hermiated discs L4/L5 & L5/S1 Aug. 2007
Reoccurrence in L4/L5 Oct 2007
DDD Dec. 2008
Dec 2008-Positive Discogram (L4/L5 & L5/S1 annular tears)
Dr. Yue at Yale Hospital, CT
Diagnosis - Need bi-level ProDisc ADR. Worker Comp Ins will only pay for one level.
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  #2  
Old 01-12-2009, 11:02 AM
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CindyLou CindyLou is offline
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cttom, personally, I wouldn't wait for FDA approval for a second level. That could be till the cows come home. You're fortunate that you got one level approved. Many on this board never got any levels approved after exhausting all appeals. I couldn't tell you what one disc costs. Ask your surgeon. He should have an idea. My 3 discs installed, including all costs, was roughly $62,000 in Germany, by Dr. Bertagnoli. Good luck!
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CindyLou
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!!
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  #3  
Old 01-12-2009, 11:34 AM
cttom cttom is offline
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Default spoke to the Dr. office

Here is the costs. $11,000.00 for the disc but approx. $25,000.00 for the additional services for the second disc. $36k if I wanted to pay for the second disc.
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Old 01-12-2009, 12:03 PM
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CindyLou CindyLou is offline
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Am I understanding this correct? Your insurance would pay $25,000 for you to have 2 levels done, and you would pay out of pocket roughly $11,000? Who is doing your surgery cttom?
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CindyLou
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!!
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  #5  
Old 01-12-2009, 07:16 PM
cttom cttom is offline
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Basically the way i understand it is, they will pay for one level. Approx 40K. The other level would cost around 36k. 11k for the disc and another 25k for hospital stuff. I was hoping the surgeons charge would be less due the fact they are already performing a surgery. They explained it was for added time for all personnel.
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  #6  
Old 01-16-2009, 11:43 PM
epiphaknee epiphaknee is offline
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Join Date: Dec 2005
Posts: 21
Default Negotiate, negotiate & negotiate...

Times are tough and nothing is cast in stone. I say negotiate. Maybe arrange a meeting with the hospital administrator and say look I'll pay the $11,000 but the additional $25,000 is just too much. It only makes sense to do two levels, so I'll either have to go overseas and have the two levels done there, where the disc costs less and the labor too or have two levels in the states on a cost competitive basis. I would offer $23,000 for the patient out of pocket part or tell them I am going elsewhere. It's free to ask.

If you can't stomach $23k, then offer what you can afford.

It just does not make sense that the second disc will have labor costs of $25,000 because it is only taking about another 20 minutes.
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  #7  
Old 02-23-2009, 09:21 PM
Deborah Deborah is offline
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Have you and/or your surgeon considered a hybrid surgery? There seems to be some discussion on whether it's preferable to do a TDR at L5/S1 or fusion (due to lack of normal motion in that segment). You might want to discuss the advisability of this with your surgeon.

Debi
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Deborah

C3-5 fused 2001
Hub: C3/4 fused 2001
Hub: TDR Prodisc L4/5, Fusion L5/S1 on 3/3/2009
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  #8  
Old 03-30-2009, 03:00 PM
JJames JJames is offline
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Posts: 102
Default Hello Tom!

Tom,
I will let you know what Dr. Yue tells me about his thoughts on the hybrid as Debi suggested at our levels after I see him on April 1st. I'm sorry you weren't able to push through the medical insurance nightmare and get what you wanted.

I'll reply on the boards so others can see too ...
__________________
DDD diagnosed ~99
Chronic Pain since Aug 2006
Failed L4 Microdisctectomy Apr 2007
2008-Positive Disco (L4/L5&L5/S1 annular tears)
Herniated discs at L4/L5/S1, bulging T12
Began constant/severe neck & upper back pain 11/09
Jan 10-Cervical/Thoracic MRI:bone spurs+new disc probs
Cervical Spine issues causing terrible pain beginning in July 2021 - scheduled for 2 level C-Spine ADR on Oct 19th 2021 now!! Part of Clinical Trial so unsure if Mobi-C or Baguera C will be implanted ....
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  #9  
Old 03-31-2009, 11:06 AM
treefrog treefrog is offline
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Posts: 65
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JJames, I want to thank you for offering to post what Dr. Yue says about hybrid surgeries. I have heard both arguments, on fusion or TDR at L5/S1.

Good luck with your appointment tomorrow.
__________________
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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  #10  
Old 04-02-2009, 02:29 PM
JJames JJames is offline
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Join Date: Nov 2008
Posts: 102
Default Wish I had some news ...

Quote:
Originally Posted by treefrog View Post
JJames, I want to thank you for offering to post what Dr. Yue says about hybrid surgeries. I have heard both arguments, on fusion or TDR at L5/S1.

Good luck with your appointment tomorrow.
Hello Cathy,
Unfortunately I came up empty at my appointment with Dr. Yue. I never even got a chance to ask any questions about surgical option. He has ordered another MRI, which makes sense as it's been quite awhile since I had my last one, I've been in a car accident since then, and my pain levels have doubled what they were previously.

Comically, he also gave me an Rx for more PT! I wonder how many times you have to have PT before it fixes discs with annular tears. Perhaps it is the eleventh attempt! If that's the case I should be cured in the near future!

Sorry, had to vent a little. Once my MRI has been done and I see Dr. Yue again, I still plan to discuss the Hybrid and any other options with him. It could be a couple weeks (at least), but I will post whatever information I am given.
__________________
DDD diagnosed ~99
Chronic Pain since Aug 2006
Failed L4 Microdisctectomy Apr 2007
2008-Positive Disco (L4/L5&L5/S1 annular tears)
Herniated discs at L4/L5/S1, bulging T12
Began constant/severe neck & upper back pain 11/09
Jan 10-Cervical/Thoracic MRI:bone spurs+new disc probs
Cervical Spine issues causing terrible pain beginning in July 2021 - scheduled for 2 level C-Spine ADR on Oct 19th 2021 now!! Part of Clinical Trial so unsure if Mobi-C or Baguera C will be implanted ....
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