I need a two level cervical ADR...Help!

[Kelly4ADR]

Who has had a two level cervical ADR ? I need two discs fixed and I doubt my insurance will cover it ;( . I do not want a fusion. I'm i going to need to fly to Germany and pay an arm and a leg to get a new neck?

[jss]

Kelly,

Condolences on this double conundrum; needing a two level ADR AND probably having to pay out of pocket for the treatment you want. There are a number of us that have had double cervical ADR's. As you're eying Germany, I'm assuming that you're looking at Dr Beirstedt? If you'll browse through the surgical outcomes forum, you'll find a few who had their double cervical ADR with him.

You're probably right in that your insurance won't pay. I'd encourage you to not give up so quickly as a search of the Insurance Hell forum will uncover a few that have had payment for a European double cervical ADR covered by their insurance. Though so far the only one's I can recall that have been covered have been those that payed out of pocket and then filed with their carrier when they returned. Even so, I think your chances would be better to get a pre-certification from your insurance BEFORE you leave. They really have no incentive to reimburse you after you get back. But if you can show them that they'll save big $$$, it follows to reason that they'll be more likely to jump on that.

The Mobi-C is now FDA approved for multi-level implantation in the US. Dr Zeegers in Germany has been using that device with great success for years. That sounds like your best bet for avoiding sacrificing your savings for a trip to Europe.

Good luck, Jeff

[Kelly4ADR]

jss,

Thank you so much. Your reply was the first I have received from someone who "gets it." and this tough girl has tears... I have lived with pain for ten years...three years ago when I was in the Dr.s office and through all the mumbling heard the words "surgery" and "fusion" in the same sentence I said my thank yous and politely left. now...l find myself on this forum where I know no one but feel close to everyone. I am prepared to appeal my insurance denial and have a US Dr. Right in my back yard who is leading in this industry that I'm hoping can handle my case and surgery, but it is so comforting to have a team of supporters that I can relate to. Hugs.

[adrigail]

Kelly,

I was able to get insurance approval (Cigna) for a single level lumbar ADR. It took several attempts and a Surgeon who was very persistent.
Keep pounding away at them, the more positive outcomes the better. Each year I believe more people are having success with the surgery, which provides more ammunition with which to convince your carrier that ADR is a viable alternative to Fusion.
Good luck and know there are some really good people here that have traveled this road.

mike

[LauraB]

Kelly,

I'm a recipient of a two-level ADR sandwiching a prior fusion. I could NOT have ADR surgery here due to the adjacent fusion level - this aspect has not been FDA approved in the US. Dr. Bierstedt was my surgeon of choice and I have absolutely no regrets in my decision. I did pay out of pocket and had to reach deep into my savings and creative financing. There is a good chance that my BCBS insurance will pick up the cost. In recent months there have been several posts of insurance reimbursement - so it is promising. I should have an answer within days and will be happy to share my anticipated success - keeping optimistic

Whether I am successful with my insurance plan or not, it saved my quality of life. Once fused - you can't go back, and living in pain was not an option. My own personal physician put it in perspective. With the surgery, I have the opportunity to continue to earn a living and easily recoup the expense; without....well I was looking at the inevitable - disability. I had to reduce my full-time status to part-time during my 5 year "wait" for something better. I've already stepped up my workload and nearly back to a full-time routine.

This is a personal decision you need to make for yourself as each of us experiences our own perspective and tolerance. I would be happy to share any of my experience with you if it helps. I would strongly urge you to inquire about alternative interventions in lieu of fusion. More than likely if you solicit your insurance company (presurgically), you will probably get a negative response for potential reimbursement....but don't give up. Acquire as much information as you can about ADR - you really need to be your own advocate.

[Kelly4ADR]

Laura,

Wow, that's amazing that you feel that much better so quickly! I am ready to do this! I'm hoping to press forward with appeals for the two level in the states, but mentally preparing for a big bill. I don't even know how much a surgery like this will cost...


Please let me know if you get reimbursed!!! I feel every win for the patient means a win for the whole community.


Thanks everyone for your replies... I had my CT today and will be reviewing that with my Dr soon. I can see a large bone spur, and I hope it won't prevent me from getting the ADRs. I also have a second opinion scheduled on March 3 with Dr. wohns in Puyallup. He is a leading expert in this area and did the 3 level for ADR member Michelle.


I'll keep you updated!

[bwink23]

Originally Posted by Kelly4ADR

Who has had a two level cervical ADR ? I need two discs fixed and I doubt my insurance will cover it ;( . I do not want a fusion. I'm i going to need to fly to Germany and pay an arm and a leg to get a new neck?

What insurance do you have Kelly?

[Kelly4ADR]

I have Aetna

[bwink23]

Kelly,

Do a search on here for Aetna...many patients have success getting ADR covered with them...seemingly moreso than any other insurance carrier...the question is if they will cover a 2-level. Lucky for you the Mobi-C has recently garnered FDA approval for 2 levels...go to a good surgeon who will go to bat for you, get you a letter of medical necessity for the 2-levels. Call your insurance and tell them about it and see what they say.

Texas Back Institute were actively involved in the FDA trials for the Mobi-C, and they have as much experience with ADR implants as anyone in the country. Plus, it seems as if their patients have a high success rate of insurance coverage.

[MMsC5-6-7]

Hi Kelly,

I have also been advised (two neurospinal surgeons) to have fusion at C5-C6, C6-C7. I DO NOT WANT FUSION. So my ADR research has begun. I also have Aetna insurance (Aetna International as I live in Dubai right now).

Please advise us on how it goes with Aetna - I haven't approached them yet with my request for ADR. This is all so new to me still I need to get my ducks in a row first.

Best of luck - I'll keep an eye out for your progress!

Melissa