prodisc

[Mariaa]

I've got to call The Spine Center and try to talk to the surgeon proposing the fusion/ADR/Prodisc for me and see what news he has if I can get thru to him.

He was just sent a letter from my WC carrier stating they were holding him in a "good faith dispute" over his report he sent in re surgery proposed. The letter goes on to state what is needed to move forward however, I can see where a technical mistake will get the proposal booted straight back to square 0~ hope someone in that office is familiar with all the new WC requirements~ I don't think he is ...

Let's see a pool .. hmmmm, I like June 2 also and if not by June 2, I say July 4th.. Independence Day! Tho truly hope it's sooner~

[chasswen]

well im giving the fda another month for prodisc approval if they are still done nothing i must say its time to contact pro-spine and dr b
i dont think i can wait much longer then that.yesterday i when to bed at 4pm and didnt get out of bed untill 6 am this morning it now feels like bone to bone rubbing. its 3 yrs looking for some resolve 4 or5 surgeons later and nothing ive lost all faith in the american heatlh care and the people whom have the last say aka the insurance companys.
chuck

[Mariaa]

Chuck,
I called the surgeon's office asking to leave a message to speak w/him re some questions and was told his PA would call me back. She did and she didn't know the answer to any of the questions I asked so she said I could leave a message with the Research Dept and someone would get back with me. That was Wednesday afternoon.

I was just reading the 2nd non cerification I got from UR/WC and am seeing that I probably won't get anywhere with an appeal even unless Prodisc is FDA approved at the very minimum.
Wonder now whether Charite disc replacement at one level would work just as well (fusion at L5S1).. however, even tho FDA approved, am thinking this request for authorization would be shot down as well..

I've already had 2 non certifications for 2 level ADR (one with the trial and Prodisc back in '04 and one recently that wasn't even asking for authorization for surgery but rather giving an opinion and making a referral for someone that could do a 2 level ADR).

The 2nd non cert even goes on to say that fusions (other option for me)yield poor results but have been around for a much longer time (in so many words)..

For me, I believe WC is looking to settle and settle low~ getting out of authorizing surgery altogether no matter how many surgeons proposed it to date...

Ultimately, I am thinking along the very same lines as you~

[Alastair]

Hi chasswen,
You can always come to the UK and Mr Lam (We call our top Surgeons Mr - -you keep the Dr thing) who is a wizard with Prodisc. I have lost count of the number he has done- - - - we eat proper food here and speak your language -- -well almost -- - lol

Who ever accompanies you could go sight seeing in London whilst you recover for a few days.

Country Cousins you are always welcome here
Best
Alastair

[chasswen]

well i was told activ-l suited me better due to the fact its low profile only 8.5 mm in the rear of the device. im very close if not bone to bone at l4- L5
and have stenois but dr yue says im still a candidate for the study because where the end plates will sit r still pretty good. but in the last few days man it feels like they could be rubbing. marria ill meet in the bogen along with my wife
i dont think i can wait on the fda.
also my wife and i would like to relocate but now the back interfears with that also.
chuck

[Kim]

Chuck
Just read your posts and can empathize big time here I have had a nasty last month increase in pain and been in bed for days straight! This waiting and not knowing anything is for the birds!
Every time I get a new opinion it seems that I am more confused than I was to begin with. What started out here as a sort of moderately difficult decision has come to a much more so one. My last MRI showed more deterioration and damage and more facet involvement so now the question for me is do I go ahead and do the combo fusion/adr that the ins would pay partially for? My OSS is concerned about me havin the Charite now, I am consulting with some docs on this to see what I should do. This is very frustrating and I am about ready to throw in the towel and either look at London or Dr B.
Wish the money was just lying around to do so would have been there already WHEW!
Hope that you feel better soon!
Kim

[chasswen]

thanks kim
i wish i had the money kicking arround myseft but i'll have to borrow against the house.but then again it's not much more then my last car so if im ok afterwards all will be ok
enough is enough though
maybe we could all have a party at trace's house
afterwards of course
chuck

[Kim]

Chuck we are in the same boat will have to borrow etc out the wazoo to get the funds to pay for it if I go to Europe. It just galls me to think that in order to have my health I have to be indebted tfor 10 years when it should be a covered expense. I know I am preaching to the choir here and it does get to a point like we are at that its sink or swim.
I mentioned this somewhere jokingly but thought I would throw it in! If all of us who are waiting go at the same time to LOndon or ProSpine maybe we could get a group discount and have a party afterwards? lol
Better to laugh than to cry and my tears are all dried up today

[chasswen]

you are 100% correct in it should be a covered expence.but it seems even with the outragous permuims we pay to the insurance company.they have the last say and even after battling BLUE CRAP over adr and being denied all 3 appeals with professions doing the letters. what really gets me is i get caring letters from blue crap acting like they care it just totally blows my mind. but now at this point im begining to feel ill end up less gray hair if i deal with it on my own. sad but true.
chuck

[Kim]

Hey Chuck I totally agree with you and dont want to start a rant here but I think the most infuriating thing is we do pay outrageous premiums to have health care and then we are told that some beaurocrat who cares nothing for us or has any medical knowledge or anything has the right to determine our fate in this! The bottom line for them as we all know is how much money they can hang on to at least one more day to acrrue interest.
I honestly dont know what the answer to our healthcare dilemna is here in the US but I do know our plight is a just a ripple at the surface of a much bigger problem.
U are right in another thing, I can see where by taking control of the situation it would make you feel much better about what u are doing.
I know for me one of the worst parts of this has been the feeling of being out of control and having to cow tow to someone elses thoughts as far as if I deserve treatment for my problems or not.
Good luck and let me know what you decide to do!
I hope and pray that we hear something on Prodisc very very soon!
Kim