Hi, I'm new here. My name is Apache.

[Mariaa]

Apache,
Welcome, and glad to hear your son survived these disasterous events..

I've been with WC lifetime future benefits since the mid 80s tho when my case was in litagation I felt the same about the inhumane treatment and every once in awhile have this recurring thought when the wait is so long to get anything in gear going thru the red tape..

Your son is very fortunate to have parents that are willing and able to pay for the ADR surgery should he be a candidate and able to brave going abroad for this surgery.

I can understand his fear re the follow up doctor situation but he would be able to find someone as more ADR surgery is being done in the US and there are some very experts here even in the US in various states.

With WC he should be able to designate his Primary Treating doctor here, tho if some kind of ADR addition to previous fusion type of surgery is not done in the US yet, if going to Europe for surgery WC may deny it, and possibly will not pay for anything with regard to benefits or follow up afterwards... at least that's how it will go for me if I were to go to Europe for surgery.

However, if he were to get his life back with regard to his spine and be able to return to work w/o problems/pain, that would be wonderful and worth every inconvenience I would imagine~

I too have 3 discs with problems tho no fusions to date on any although it was suggested multiple times for L3-L5S1 (global fusion/anterior/posterior).

Also two level ADR has been suggested, and a combo ADR and fusion..

I'm hoping to finally end up with the multiple level ADR surgery authorized and paid for by WC tho we shall see ...

If it were me, and I were your son's age I'd want to be assessed by surgeons doing ADR both here and abroad to see what options he might have besides more fusion as I was told that even if I fused L3-L5S1, I would likely need L1 and 2 fused as well, and no certainty could be given as to how soon or long after the 3 level global fusion was done..

I hope your son will give it some thought before considering seriously more fusion.. I know I would faced with a similar situation altho I do understand his concerns~

Please tell him to come here and visit with us and read the surgical outcomes part of the forum as well as maybe post himself and talk directly with people if he will...

take care and sending my best to you and yours, Maria

great post mariaa
chuck

[Harrison]

Maria, I agree with Chuck! Thanks for helping our new member...you rock!

Hey guys!
Everyone is so nice! Thank you for all for reaching out. Maria, your post is really helpful. It's clear that you know, all too well, what problems Josh is facing. I sure hope things work out for you.
I spoke with he & wife over the weekend - learned that they are afraid of going to Europe for the surgery because if it doesn't work out, they'll get nothing from WC and his wife will be stuck supporting them all their lives. I had not looked at it from that angle and don't believe it would turn out that way, but of course, there is no guarantee and I can see where the kids are coming from. (My perspective has been - get him fixed by the best, get him back in school (engineering student 3rd yr) and he can make his own living & to heck with WC!) If he could settle with them soon, they said they would go to Europe in a heartbeat. That's not likely, so I think you are right about seeking an experienced USA doctor. I spoke to Mark ******* this weekend - I hope he can help.
Y'all are great!
Thanks,
Apache

[Mariaa]

Apache,
I had authorization for a 2 level ADR 2 years ago with WC here in CA. tho I was too afraid to have it done, and now I've been fighting the good fight to get that authorization back~ I just heard today that WC is once again referring me to the surgeon where I would have the surgery done (The Spine Center in Santa Monica) and I am to call tommorrow and get the appt. set up.
So, things are moving right along for me.

Yes, If I were to go abroad, without the authorization from WC to see the surgeon abroad (and they won't authorize that altho someone here did get auth from their WC insurance)~ I would lose my Lifetime Future Medical Benefits and right to be treated afterwards..

However, I could settle out those benefits first and then use the $ altho now because people in the past were settling their future med benefits and then spending the money meant to pay for their health care issue on other things and using Medicare benefits if they had them to pay for their health care~

When I received my Medicare health benefits I had to sign a form waiving benefits that were covered by WC insurance(for being totally permanently disabled) and now one must do something called a set aside fund or something else in terms of the award but to used for health care purposes on the injured part that WC was covering~ I think there are several ways to work this out; or just hope to be covered some other way if you choose to use your $ the way however desired rather than for the healthcare funds to be set aside ...

I went to the WC forum at www.braintalk.org and TamaraShadow who is an injured WC attorney has done a good job of making some of this information more easy to understand, at the moment at least because I've forgotten exactly what she said.. tho it's not all as easy and wonderful as it used to be (tho then again, what is?!).

I guess there were too many abusive or fraudulent cases/lawyers/doctors of WC funds being used inappropriately for too long~and Medicare system being drained by people that were actually should have been covered with WC benefits..disorganized and/or dysfunctional systems...

So yes, I understand how your son is thinking, I've have to consider the very same things re WC..

Good luck to him whatever he decides to do!

Mariaa,
I will refer Josh to the WC forum that you mentioned. It helps to understand why it is important to wait on WC. I know you are thrilled to be able to get your surgery approved! That's great! I am in favor of set aside $$ for future.

Unfortunately, the administrator of his WC insurance is worst I've ever heard of. It took them 3 weeks after the accident to assign him a case worker (Josh calling them regularly to try & find out proper procedure & get a doctor assigned, to no avail). Of course, they refuse to pay the ER bills because he was supposed to wait until he heard from them before seeking medical attention! (yep, 3 weeks -no lie!) And I suppose the fraudulent ER doctor put him on a morphine drip for his enjoyment rather than for controlling his pain and critical vital signs. Obviously, electrocution doesn't fit into WC's definition of "emergency". (We didn't know anything was wrong with his back, at first but broke back probably wouldn't have made any difference.)

I'm sorry for being so sarcastic - I begin to see red when I think about what he has had to endure. As soon as I am able, I will be doing my best to educate our legislatures about the laws they have passed that are allowing unscrupolous administrators to treat injured workers as if their life is worthless. Of course, the reason given is always because of the numerous "fraudulent" claims. Quite frankly, I doubt it's as bad as they would have us believe. However, even if that were the case; the correction is not to penalize the injured worker, but to fix the broken system. My guess is that this route is cheaper and easier.

Thanks for taking the time to share with me - & letting me vent, too.

Apache

[Harrison]

Maria, thanks for your ever-thoughful posts. I've visited Braintalk and love the diversity of information -- but it's easy to get lost -- especially as a first time visitor. What forum should Apache visit?

[ans]

Hi Apache,

Can't add more than what's been said other than you and your family have my best wishes. Talking about a lot on the table..

Allan

[Mariaa]

Harrison,
Sorry, used WC for *Worker's Compensation* Forum in my post to Apache re the WC forum at www.braintalk.org

Apache,
Things move fairly slow with Worker's Compensation, at least in comparison to what we are used to with other health insurance coverage, even HMO coverage.. this is with an attorney. Without one I'm not sure anything happens.

I wasn't assigned a Case Manager until I had already had 2 spine surgeries... and that was from a period of 1982-1992, acutually 1993 because I wasn't assigned the NCM until the surgery failed and I was asking for referral to a Pain Management Program.

I can well imagine just how your blood must be boiling with regard to the treatment your son is receiving under WC~ it's enough to drive one certifiably crazy and my personal feelings are this is part of the tactic utilized so the WC client may opt out of continuing on with the case, and settle for whatever amount of cash that would be offered, or to use other insurance or methods to take care of the problem.

Sometimes one has to do either of those things and it works out to his or her advantage. I think a few persons on this forum have gone to Europe for surgery and far benefited from surgery there vs. probably waiting around until the x amount of years for WC to approve or disapprove whatever treatment..

The "set aside" fund I mentioned is something that needs to be fully understood before undertaking when it comes to settling benefits. I'm not sure I would want to "go there" at this stage of the game with spine, however, maybe if I hadn't had any surgery done yet, or if it were a recent injury I might more readily see settling my benefits as a more viable option...

Re current authorization with my case, at this point in time, so far am authorized only for consultation with surgeon that evaluated me two years ago and said I was a candidate for multilevel ADR tho I didn't feel comfortable w/it back then so didn't go for it.. (when WC insur. co was willing to pay even tho UR denied surgery).

My Nurse Case Manager told me that after seeing the surgeon, if I'm offered the same option of two level ADR, the request still has to go thru UR for approval. I'm pretty certain that since I haven't had a discogram done in several years that would be recommended again, or at least for me to move on this, it would be.

If the request for authorization for surgery is sent in w/o that, probably a denial or request for further information will come back and most likely request for Evidence Based Medicine (or medical studies/data/literature supporting ADR vs. fusion ~ would have to show that it's the optimal choice in surgery for my case for whatever reason, and that outcome for multilevel ADR is as good if not better than outcome with multilevel fusion...

etc. ad nauseum..re my case~

Here's another website I may have already referred you to www.workcompcentral.com
** check out becoming a member and seeing what's offered.. good for info in any/all state(s)~ esp. access to type of material if one can afford it..

Cotinued good luck with your son's endeavor with WC, may it be short and successful vs. long and drawn out..

[Dale S]

Apache,

Please let me add my welcome to this forum.

In my adr research, I discovered that fusion can be the cause for future degeneration of adjacent discs which bear the burden of the fused disc. Everyone is different and this is something that your son should discuss with his doctors while his options are still open.

I also had 2 discectomies from the back prior to my adr surgery. Surgically speaking, healing from the front was quicker than from the back.

Dr. Bertagnoli did my adr surgery in Germany. No on didn't want to go there more than I. I found every excuse I could think of not to go but the final straw was my insurance company's refusal to pay for the surgery. Finances forced my decision to go to Germany. All of my fears and what-if scenarios were unfounded. I was proven wrong. The language barrior is not an issue and the expertise of both Drs. B and Z is unparalleled in the US.

No doctor can guarantee any outcome but choosing both the procedure and doctor carefully should be part of your son's decision making process. I didn't choose carefully our of fear of surgery in a foreign country, flying over there and back, and a host of other concerns. The flights weren't pleasant but that's the only negative I experienced. The medical care I received in Germany was better than I received in the US and though I still want to be reimbursed by my insurance company, I have to say it was money well spent.

Good luck to you and your son. I wish you good fortune.

Dale