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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 10-10-2010, 04:13 PM
d1rk d1rk is offline
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Join Date: Oct 2010
Posts: 13
Default Insurance Approved Prodisc-C C6-C7

Greetings all. My name is Mark. My story started almost 11 years ago, it was my turn to feed my infant daughter in the wee hours of the morning when I slipped on the stairs with her in my arms. It's amazing how instinctively you don't even consider protecting yourself in that split second. Months after the fall I was diagnosed and required a fusion C5-C6. By that time I had significant atrophy in my right arm along with numbness and pain. Fusion went well.

5 years later I was again back with pain and then diagnosed with C6-C7 herniated and causing me trouble. Knowing that this was caused by the previous fusion I have been fighting off another fusion for over 5 years now. I recently had a NS submit to insurance for an ADR. We were basically going through the motions as he stated that they won't approve it. Shortly after I received the denial letter from insurance. Going through the motions again I appealed. To my surprise it was shortly after approved.

I'm planning to have this done in November with the Prodisc-C. Unfortunately the NS has done only a couple of these as only workers comp patients historically could get it approved.

I've read a lot of good information here in this community already and am happy to join it.

My insurance is self funded by the healthcare organization I work for and managed by United Health Insurance.
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  #2  
Old 10-14-2010, 01:43 PM
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Harrison Harrison is offline
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Hi Mark, I hope we can help! Is your question primarily about the surgical team's experience? BTW, it's great that United will cover this if you are a good candidate for disc replacement!
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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
Donate www.arthropatient.org/about/donate
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  #3  
Old 10-14-2010, 09:34 PM
d1rk d1rk is offline
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At this point I'm just telling my story. I plan to contribute with my post op experience. I've found the experiences posted here very helpful.

I happen to work for a hospital / health system as an IT manager and have some extra resources that someone off the street may not have. For example because my office is near the sterile processing department I was able to speak to the Synthes rep about the NS I'm working with, his partners and the experience and training they received. I was also able to speak with some leaders in the surgery departments at the hospital about them. The Synthes rep told me that the NS I'm working with is very conservative about candidates for ADR. He also felt that most people just take the denial letter from the insurance companies and don't attempt to go through the appeal process.

Anyway I hope to tell of a positive post op experience to this community. I have yet to get a date for surgery but expect to very soon.
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  #4  
Old 10-14-2010, 09:59 PM
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Harrison Harrison is offline
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Thanks, Mark for explaining. Glad you've done your homework. Have you already seen this topic?

http://www.adrsupport.org/forums/f51...ications-9620/

This is interesting -- that your office is near the sterile processing department -- how would your path to treatment be if you did not "bump" into the Synthes rep?!
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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
Donate www.arthropatient.org/about/donate
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  #5  
Old 10-14-2010, 11:07 PM
d1rk d1rk is offline
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It actually was really weird that he showed up to meet with the sterile processing manager as I was asking her about whether they see the kits and tools for these procedures. By this time I had already seen the NS, talked about the device he uses and was on the road to this procedure.

Thanks for the reference. I don't see anything there that would disqualify me. I was actually surprise when the NS told me that my procedure would not be off label. I thought a previous fusion disqualified me.
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  #6  
Old 10-31-2010, 01:29 AM
d1rk d1rk is offline
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Scheduled surgery for November 11th. I'll submit my post surgery experience after that. Being told that it's outpatient. My fusion 10 years ago was a 1 night stay and 2 weeks off but this is guy is telling me 1 week. He has to remove the existing screws and plate and then work on the lower disk. Seems more extensive then the previous fusion. I guess taking bone from my hip last time is the difference.
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  #7  
Old 10-31-2010, 03:55 PM
JPJH JPJH is offline
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Join Date: Dec 2009
Posts: 70
Default Will The Insurance pay if?

Will your insurance pay if you go out of the country for the ADR surgery? If so I would recommend you check out the Dr's now doing the M-6 ADR in Spain, England & Germany. You can pretty much guarantee your insurance carrier it will cost them a whole lot less (Even if they pay your travel expenses) and I personally think the M-6 ADR is the device to use these days. It is not available in the U.S. even though it is made here? You gotta love the FDA!

Just food for thought.

JPJH
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  #8  
Old 11-01-2010, 09:40 PM
d1rk d1rk is offline
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I appreciate the recommendation. That is an interesting device. Almost looks like they guts can be replaced leaving the keel plates fused to the vertebrae. I'm already 30 days into my 90 day window to get this surgery done. I'm good with the Prodisk. Hope it works out for me. Over 5 years of fighting off a fusion. I'm so sick of having to depend on someone else to give me a prescription for pain. They have an MRI that shows a major herniated disk but make you fight to get pain medication. After several providers I'm tired of it. At this point, the time seems to be right to get this done. Many options there are not.
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  #9  
Old 11-02-2010, 12:52 AM
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jss jss is offline
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Mark, congratulations on the approval! A lot of us go through a lot more grief than you've had to endure and still can't get approved.

I see that you're hoping for surgery in November. Have you scheduled a date yet? Please keep us posted.

Good luck!

Jeff
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #10  
Old 11-06-2010, 10:34 PM
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nofusion nofusion is offline
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HI Mark, I feel your pain Good luck with the operation and please keep us informed.

Your other disk only lasted five years after the fusion ?

I hope these replacements work as advertised. I'm scared to death! I had a rt inguinal hernia repaired 2 years ago and it still bothers me.

The thought of having my neck dug into makes me sick

and now this talk of auto fusion caused by heterotopic ossification
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