read this denial (2nd appeal)

[jf110]

Uphold non-certification charite artifical disc replacement:
The information provided does not establish the medical necessity for Charite lumbar disc artifical replacement procedure. There is inadequate documentation in the peer reviewed literature of randomized long term outcome studies to prove the effectiveness of this procedure when compared to standard surgical procedures for degenerative disc disease. Most published studies consist of retrospective case series,small sample sizes,and short term prospective studies. Recent literature includes only two year results and is compared to interbody fusion.On the basis of the literature, there is currently insufficent data to asses the long performance of total disc adequately. An artifical disc replacement procedure is investigational and experimental AT THIS TIME. (Well, contrary to what there medical doctors stated, I sent them a lot of proven documentation showing results with adr post -op results with 5,10,and 15 year results. These results came from here in the U.S.A. and in europe!. The results clearly states the clinical benefits over a fusion procedure, plus the long term benefits. We all know the outcomes of fusion down the road. MORE SURGERY!!MORE DISC PROBLEMS!! EXTC.I will keep plugging on and get the insurance coverage for the adr surgical procedure i need. Anyone that reads this can shed some light on this matter and offer me some suggestions i would certainley appreciate that. Thanks, JF

[Harrison]

JF, hang in there. I hope that your tenacity and patience win out against the insurance beancounters!

Good luck with the third-party arbitration process...keep us posted!