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#1
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Approval by Veterans Health Administration...
YES!!! I just received information that my preauthorization request to have the Veterans Health Administration cover my Lumbar ADR procedure was approved. I wasn't sure if I would get approval because I read that the VA would not cover procedures to be done overseas and could find no one that had gotten approval domestically.
That said I'm only having ADR at 1 level (L4-L5) and my private insurer (Anthem BC of CA) denied me previously. I will continue to fight my insurance company with the hope that potentially winning approval will further push them to change their anti-Lumbar ARD policy. Wish me luck! |
#2
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Good luck! Keep going!
__________________
"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 |
#3
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Quote:
Anthem Blue Cross coverage position SURG.00055 Artificial Intervertebral Discs Anthem B/C Position Statement Investigational and Not Medically Necessary: Lumbar artificial intervertebral discs are considered investigational and not medically necessary. Appeals may get you moved forward. The above text is from Anthem and it may or may not apply in California. I assume it applies. VHA: I am fuzzy w/o research again. Dr. Schoenfeld, US Army in made a comment in Spine (Note 1). I recall an AAOS meeting with military orthopaedists, fuzzy. Check your surgeon's experience, ask how many implants in a tasteful manner, etc. VHA Charles Rosen, a surgeon working in the VHA system, questioned ADR / TDR design, trials, etc. To Dr. Rosen's credit, he wrote "Many of these failures have been described as surgical errors in either placement or sizing, surgical approach errors, inexperience, inappropriate indications, and patient non-compliance". |
#4
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...Clarification
The approval I received was for the VA to cover having the procedure done outside of the VA system by very experienced private physician that I've been seeing.
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#5
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Thumbs up.
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#6
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So
happy to see approval for adr.
__________________
12/2008 early am gym class-something very wrong 2/2009 DDD 4 herniated cervical discs 3/3009-8/2009 8 spinal epidurals, pt 09/2009 C6/7 Prodisc C ADR 11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief 05/2011 facet Joint Inj 06/2011 Rhizotomy 7/2011 Dr. Zigler TBI, facet block and Discogram 11/18 surgery with Dr/Mr. Boeree..Thank God. |
#7
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Congrats! on your pre-approval!!!!
I'm still waiting, waiting, waiting! Keep us posted!
__________________
50 year old female Rear-Ended in 2009 Disk rupture cervical 5-6 & 6-7 2 level M6 ADR, Dr. Clavel - Oct. 2012 Insurance paid Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel Post Op 2+ years Cross Fit 3-5 times a week Running 5ks |
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