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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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  #1  
Old 09-05-2005, 02:47 PM
cervie queen cervie  queen is offline
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Am I the only one who's on Medicare because they're disabled? (or over the hill?) I have heard/read about all these insurance hassles and a few successes, but no one seems to mention Medicare as their carrier for ADR reimbursement.
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Old 09-05-2005, 03:28 PM
luvmysibe luvmysibe is offline
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I am on workers' compensation because my back injury occured at a crisis response training session in front of about 25 witnesses. I haven't seen or heard much from individuals with medicare on this site or in the community. According to my surgeon and underwriting insurance company, many people covered by medicare do not qualify for ADR because of their age. Even I had to appeal my case to the state board to have ADR rather than fusion, and I was 34 at the time of my injury. If I receive any updated information this week, I will keep you in mind.
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  #3  
Old 09-05-2005, 10:49 PM
sahuaro sahuaro is offline
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Does denial of add-on payments mean that Medicare is not necessarily denying coverage for ADR surgery but it is not fully covering all the costs?
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2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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Old 09-05-2005, 11:18 PM
Mariaa Mariaa is offline
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CQ,
Medicare is my medical provider tho WC covers my low back with lifetime future medical~ in fact, had to sign a Medicare Waiver on that area b/c of WC coverage..
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  #5  
Old 09-06-2005, 12:06 AM
cervie queen cervie  queen is offline
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I also wonder if I could circumvent their denial by having a combination fusion at two levels and ADR at one level. My figuring goes that for the fusion alone many things such as hospital stay, anesthesiologist, etc would be covered. Or is it all or nothing at all..Is'nt that a Cole Porter number?
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  #6  
Old 09-06-2005, 01:25 AM
sahuaro sahuaro is offline
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I have confirmation that non-payment of add-on means that Medicare will not pay for the device itself but will pay for surgery, hospital, etc.

The article that Amy references has an e-mail address for the public to express concerns. Since, as the article indicates, Medicare's decisions ultimately determine private insurances' decisions, it is really important for those who have had ADR to speak up.
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2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #7  
Old 09-09-2005, 10:19 PM
cervie queen cervie  queen is offline
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If you have had bone morphogenic protein in a fusion or have had other procedures, you need to speak up as presently, Medicare is not covering ANY of these procedures. Now the hospitals are refusing to see medicare spinal patients (Me, being one of them).
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  #8  
Old 09-10-2005, 12:19 AM
ans ans is offline
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Hi Amy.

I agree w/Deyo in regards to the Europeans not providing good data after many years. Also, the risks of migration/subsidence can be serious w/salvage not being an option (yet fusion offers no option). However, I respect your acuity in recognizing the sweeping importance of this one decision. - Allan
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  #9  
Old 09-10-2005, 08:40 AM
Alastair Alastair is offline
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I think the Europeans have showed lots of data not only now but in the past.

Many people have not accepted their data and many have not asked for their data -- -I think that is the "Rub"!!!

The answer people get depends on the question they ask
Best
Alastair
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