prodisc - Page 8

Ken (AKA-KP) · #71 05-14-2006, 02:59 PM

Food for thought - To those that are sick and tired of being sick and tired of waiting. Even when the FDA gets around to approving the Prod Disc it will still be a while before insurance companies will cover. The Charite has been approved since 2004 and the only insurance company paying to date that I am aware of is Aetna. Except for having to pay cash up front Dr. B offers much more experience and technology. In the end, you want the best care for the best possible outcome. With a less experienced surgeon you may not get the relief you are hoping for. I made my decision some weeks ago and still struggle today with thoughts of whether or not I have made the right decision at the right time. One thing I am sure of is I have chosen the right surgeon. Dr. B and I have a date for 6-6-6, no worries. I would like to thank ADR Support, and especially Richard, Mark and Brad for their incredible advice and support. Good Luck to all.

chasswen · #72 05-14-2006, 03:02 PM

i was told prodisc is to tall for me when activ-l is out there. and i will be submiting the bill to blue crap.

chasswen · #73 05-14-2006, 03:04 PM

kp your going to do fine

Kim · #74 05-14-2006, 03:16 PM

KP
The reason most of us that are posting are so anxious for Prodisc approval is that we are awaiting clinical trials to start up. We realize that insurance will probably not cover the Prodisc either without a fight even with FDA approval due to the track record we have seen with the Charite and insurance.
However the clinical trials will give those of us who either cannot afford or would be hard put to go to Germany as far as finding funds to do so a chance to have our surgery wihtout incurring the expenses involved. This is the reason we are frustrated, and very upset that it is taking so long to take place.

Eddie_G · #75 05-14-2006, 03:54 PM

Good luck KP. You're in great hands with Dr. B. I met him in NY last year and I would LOVE to have him work on me.

Kim: Do you think I'll have a problem like getting the rug pulled out from under me if the Prodisc is approved but Liberty Mutual balks? I fought a tough battle to get where I'm at now. Playing devil's advocate, what kind of BS can I expect from Liberty Mutual? I am approved for ADR with a Prodisc doctor. I'm ready to fight some more, but what can they possibly throw at me next? My discogram is tomorrow and I see Dr Goldstein next Monday to talk about a surgery date. I may even be first on his list after FDA approval. I'm getting my Prodisc this summer goshdarnit! I'm gathering up more papers if Liberty Mutual balks but like I said, I fought HARD to get to this point. I think they are sick of hearing from me, my lawyer, and my company's health director. Be a squeaky wheel! I feel pretty confident I'll get what I want. Especially since I recently took pictures of the trailer I fell in STILL IN USE! And STILL IN DISREPAIR! What the heck is my company waiting for, another 10 people to get hurt before they remove the broken trailer??? IDIOTS!!! They better just shut up, bite the bullet and pay for my Prodisc. I really don't feel bad about suing them after seeing the trailer still in use.

Ken (AKA-KP) · #76 05-14-2006, 05:26 PM

Hey Kim, My apologies. Good luck.

Kim · #77 05-14-2006, 08:24 PM

KP
No apologies necessary just wanted to clarify why some of us are in the state that we are in. If it was an insurance issue, I know at least I would not be chomping at the bit like I am now to see this approved quickly.

Kim · #78 05-14-2006, 08:29 PM

Eddie
You are probably in a better position than some of us in this respect. The reason I say that is that WC has approved ADR in cases that private insurances have not. If you will look at the history on the boards here u will see that many of the ones that have been approved have been WC cases. That does not say that Liberty Mutual will not cause a stink. I have learned to expect the unexpected where any insurance company is concerned in this.
What you might want to do is go to the Depuy site and look at their criteria for the appeals process. I know this is not Prodisc but it shows approval for ADR in general from quite a few different insurance companies.
If you can find Liberty Mutual there you have fuel for your fire if they balk at all in approving the procedure due to it being unproven etc which is what a lot of us have had to deal with. You have the right attitude keep at it be the squeaky wheel keep at them and sometimes it works they give in because they know that you will not.
I hope this has helped. We are all still in sort of la la land where any type of insurance approval for this procedure is concerned.
I am very hopeful that once Prodisc is approved that the insurance companies will be more inclined to at least approve one levels without so much to do.
Having 2 discs approved by the FDA and more years of results etc will give us more leverage in my opinion to get this covered.
Hope this helps

David · #79 05-15-2006, 05:19 AM

Basically Kim and I are in the same boat - we both need multi-level ADR.

The question we keep asking ourselves (or at least I keep asking myself) is how bad does my quality of life have to get before I decide to immediately have surgery?

I am trying to wait for multi-level Prodisc approval, since that will get me into the Activ-L study.

If I can't (or don't want to), then I will most certainly jump on the next plane to Deutschland.

Based on what I have seen concerning ADR and insurance coverage in the U.S., I think it would be a long wait for multi-level Prodisc apprvoval + insurance coverage (especially for me, since I have UHC).

My best guess is that I would probably be fighting for UHC coverage of multi-level Prodisc for 1-2 years, minimum. Honestly, I don't have that kind of patience... or time.

David

Justin · #80 05-15-2006, 05:55 AM

Quote:

Basically Kim and I are in the same boat - we both need multi-level ADR.

The question we keep asking ourselves (or at least I keep asking myself) is how bad does my quality of life have to get before I decide to immediately have surgery?

I am trying to wait for multi-level Prodisc approval, since that will get me into the Activ-L study.

If I can't (or don't want to), then I will most certainly jump on the next plane to Deutschland.

Based on what I have seen concerning ADR and insurance coverage in the U.S., I think it would be a long wait for multi-level Prodisc apprvoval + insurance coverage (especially for me, since I have UHC).

My best guess is that I would probably be fighting for UHC coverage of multi-level Prodisc for 1-2 years, minimum. Honestly, I don't have that kind of patience... or time.

David

Hi David,

It is evident that you are really thinking things through and being realistic about approval and insurance red tape. I remember when I was researching ADR in 2003 and there was talk about ProDisc approval in the second quarter of 2004

. Even if the ProDisc is approved, it will be quite some time before multilevel is commonplace or accepted by insurance companies in my humble opinion.

I do wish you the very best in your journey. If I can be of help, don't hesitate to contact me.

Justin