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New Member Introductions If you just joined, please introduce yourself here. Please add a signature describing your spinal history (use the "User CP) and ask us how we can help you get started.


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  #1  
Old 12-30-2021, 03:12 PM
Larry from Buffalo Larry from Buffalo is offline
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Join Date: Dec 2021
Posts: 4
Default Hello all

My name is Larry from Buffalo NY. So my L4 and L5 area is pretty screwed up. It has been bugging me for I would say 25 years(I'm 44). My guess is it was the result of a work injury around 18-19 yrs old. I went to my primary dozens of times throughout the years and they kept telling me I was fine its just a muscle.

A couple years ago I finally found out how to go about having it really looked at, and ended up at UB Neurosurgery, who does back fusions. I wasn't thrilled with the idea and I passed on it. I have been aggravating it so often at this point that I can't do much. I'm very into working out, lifting weights, body building and now I can't do any of that. My muscle mass is depleting and now I work an office job opposed to construction and it seems like sitting is worse than actually forcing myself to physically work.

So I just discovered ADR and it seemed like a better idea to me. I started talking to AIMIS with a doctor Smith. Their facility is in the country of Cyrprus .After looking through my X-rays and MRIs his comments are below, but my insurance won't cover surgery abroad and it was 80k Euros.

Quote
This young man has a severe disc degeneration at L5S1 with moderate foraminal stenosis.
There are also early changes at the L45 region with mild Modic changes.
Prior to our final recommendation, He needs to have flexion/extension X-rays of the LS spine to rule out any sign of gross instability.
In general, he is most likely an excellent candidate for a total disc replacement rather than a fusion..
However, the question needs to be answered, is the L45 a pain generator as well as L5S1 or is L5S1 the only pain generator.
Another possibility would be TDR at L5 S1 and then stem cells transplantation into L45 disc at the same procedure

Unquote

So I joined this site and researched and found Dr. Fabien Bitan. Going through my insurance web site he was in my healthcare network. He reviewed my MRIs and X-rays and said he still wanted a CAT Scan done but from what he saw, he felt a hybrid may be the best route as L5 was squished so small and bone on bone that opening it up may not be in my best interest and to fuse that one and use ADR in L4. All depending on an interview to see my physical health and the CAT scan. Then all the sudden today his office emails me that they are out of network, I call my insurance and they confirm. He was on the site last week now gone, so I am not sure what happened there.

Sooooo , he I am looking for names of other surgeons in the attempt to find one in network . Thank you to anyone who took the time to read and Happy New years.
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severe disc degeneration at L5S1 with moderate foraminal stenosis.
There are also early changes at the L45 region with mild Modic changes.
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  #2  
Old 01-02-2022, 09:11 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 6,961
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Hi Larry, thanks for posting. Do you have any special considerations with regard to travel? In New York and many other states, there are hundreds of doctors that have been performing ADR since 2000.
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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  #3  
Old 01-03-2022, 09:45 AM
Larry from Buffalo Larry from Buffalo is offline
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Hi Harrison. Travel does not bother me, the closer the more convenient but I'd would prefer a good doctor over convenience.
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severe disc degeneration at L5S1 with moderate foraminal stenosis.
There are also early changes at the L45 region with mild Modic changes.
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  #4  
Old 01-03-2022, 03:53 PM
Larry from Buffalo Larry from Buffalo is offline
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Join Date: Dec 2021
Posts: 4
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So Dawn from Dr. Bitan's office called me today. She says he is out of network so office visits are not covered, but everything in hospital should be. Seems sketchy to me and its hard to follow a little because she has a deep accent.
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severe disc degeneration at L5S1 with moderate foraminal stenosis.
There are also early changes at the L45 region with mild Modic changes.
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  #5  
Old 01-04-2022, 10:23 AM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,618
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While it should be possible to confirm with your insurance company and the hospital what's covered; like the facility charge, equipment, anesthesiologist's time, etc.; it sounds like you'll pay out of network for Bitan's time while he's operating on you as well as office visits. Unless he bills through the hospital, his bill for surgery time should also be out of network and could be quite expensive.

I seem to remember reading about a new law for 2022 forbidding surprise billing for medical procedures. If you decide to risk the cost of going with Bitan, you might want to check into the law and see what Bitan and the hospital need to disclose about estimated costs prior to the surgery so you have a better idea of how expensive the surprise might be. For that matter, consider who else at the hospital might be out of network for you. If Bitan suddenly needs extra help because of some difficulty with your surgery, those extra people might or might not be in-network for you.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #6  
Old 01-05-2022, 10:27 AM
Larry from Buffalo Larry from Buffalo is offline
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Join Date: Dec 2021
Posts: 4
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Quote:
Originally Posted by annapurna View Post
While it should be possible to confirm with your insurance company and the hospital what's covered; like the facility charge, equipment, anesthesiologist's time, etc.; it sounds like you'll pay out of network for Bitan's time while he's operating on you as well as office visits. Unless he bills through the hospital, his bill for surgery time should also be out of network and could be quite expensive.

I seem to remember reading about a new law for 2022 forbidding surprise billing for medical procedures. If you decide to risk the cost of going with Bitan, you might want to check into the law and see what Bitan and the hospital need to disclose about estimated costs prior to the surgery so you have a better idea of how expensive the surprise might be. For that matter, consider who else at the hospital might be out of network for you. If Bitan suddenly needs extra help because of some difficulty with your surgery, those extra people might or might not be in-network for you.

Hi annapurna, after consulting with my insurance provider, you are exactly right.
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severe disc degeneration at L5S1 with moderate foraminal stenosis.
There are also early changes at the L45 region with mild Modic changes.
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