Cervical ADR - Insurance and Costs in Omaha area

[Fred_2010]

Hi, I am new to this forum.

I am a 51 year old male, physically fit and in generally good health except for my neck. After initially being told by Cigna that cervical ADR would be covered, my doctor received a pre-certification decline letter on the grounds that single level ADR (C6/C7) was still experimental. I am, however, also covered by Blue Cross Blue Shield of Nebraska. I was curious if anyone had experience with Blue Cross Blue Shield of Nebraska? In the event BCBS Nebraska also declines, does anyone have any current out of pocket cost data on this procedure (in Midwest / Nebraska)?

Also, I was given the option of fusing C5 - C7 because if was felt that fusing just C6 and C7 would wear out the C5/C6 disc fairly quickly. I am fearful of spinal fusion, because it seems to do more damage than good. Am I incorrect is saying this regarding cervical fusion procedures?

I have been dealing with stabbing shoulder and left arm pain when I tilt my neck back, and numbness down to my fingers. This started in 2007, when I was misdiagnosed as "tennis elbow". After going through two rounds of physical therapy and traction, I want to get something done. I don't want to go to Germany either.

Thanks in advance for your responses.

Fred

Two factors offsetting the out of pocket expenses would be increased medical itemized deductions and savings when I drop one of my insurance policies.

[jss]

Fred,

I can't speak to Omaha, but in 2008, Dr Jack Ziglar at The Texas Back Institute in Plano, TX told me during an office visit that paying out of pocket for a cervical ProDisc at one level would cost about $50,000.

In Dec 2009 I paid $27,533 for a two level Spinal Kinetics M6 cervical surgery in Barcelona, Spain.

Good luck, Jeff

[Fred_2010]

Jeff,

I find it outrageous that one needs to leave the country for this procedure in order to save money.

Thanks.

Fred

[annapurna]

Much of it seems to be driven by the definition of malpractice in each country. A more stringent definition leads to fewer successful malpractice suits which leads to lower malpractice insurance for those practicing in the country. You could easily make the case that we're sue-happy in the US. You could also easily make the case that the fear of lawsuits can drive better work within the US compared with countries with better protection for their doctors.

[CharlesinCharge]

I agree that with the U.S. being a sue happy country that drives up the cost of medical procedures. However, the countries where one can get ADR for a much lower price (Sweden, Germany, Spain, etc.) are also countries that for the most part practice socialized medicine. Doctors make much less money there than in the U.S., and medical care costs much less because it is government subsidized.

I remember when I got my two level ADR in Germany (which cost about $30,000) and I looked at the itemized bill, the surgeon's fee was $5,000. When I had my XLIF procedure here in the U.S. two years later, it cost over $100,000 (all paid for by insurance) and the surgeon's fee was about $20,000 of that. A top-flite orthopedic surgeon in the U.S. with a thriving practice can make well over $500,000 a year---surgeons in Europe do not make that kind of money. In addition, I remember that the anesthesiologist's bill for my XLIF was about $7,000 (for two hours of surgery) whereas in Germany it was less than $1,000. In a socialized medical system doctors simply don't make as much, and that savings is passed onto patients. That is why so many foreign doctors come to the U.S. to practice medicine, as they can make more money here than anywhere else in the world. Someone has to pay for that, usually your insurance company, but if it is a procedure that is not covered by insurance (like ADR) it will be you.

[Harrison]

Charles, really?! What do you think the German surgeons are paid? Is it true what some patients in this community have reported -- that they have offshore bank accounts in Cypress? With bus loads of patients going their monthly, they are not making BIG bucks? Please.

And in socialized medicine, which comes in myriad varieties, savings may or may not be "passed on to patients."

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Originally Posted by CharlesinCharge

Doctors (in Germany) make much less money there than in the U.S., and medical care costs much less because it is government subsidized...

...A top-flite orthopedic surgeon in the U.S. with a thriving practice can make well over $500,000 a year---surgeons in Europe do not make that kind of money.

...In a socialized medical system doctors simply don't make as much, and that savings is passed onto patients...

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Jeff, that cervical ADR price can't be right -- at least for 2009 or 2010. I'll check, but also see the FAQ on ADR pricing. Sorry Fred, for hijacking your topic!

Back to you sir...

[CharlesinCharge]

Richard,

I am not sure exactly how much doctors in Germany earn, but I GUARANTEE it is less than in the U.S. I have read surveys and U.S. doctors are the highest paid in the world, bar none. Like I said, I also saw the itemized bill for my ADR in Germany and my XLIF here in the U.S., and the differences were staggering! I even recall that the hospital fee in Germany (surgical room) was only about $1,500 whereas for my XLIF procedure they charged $8,000 (and it was an outpatient procedure, I left that same day!).

Socialized medicine has its problems and issues (I have read that in Canada people routinely wait 6-8 months to get an MRI, I can get one here within 2 weeks), but they pay less money because the government is subsidizing the cost. I am pretty sure that is at least part of the reason why one can get a procedure like ADR so much cheaper overseas than in the U.S.

[annapurna]

To come back to my point, US surgeons incur huge risks. Many foreign surgeons don't. If you want to make a huge amount of money, work in an industry where there's huge risks and get lucky enough to not get burned.