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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #1  
Old 06-26-2005, 02:27 PM
bmills bmills is offline
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Still trying to determine what to do.

Denied at final appeal with insurance for Charite at L5/S1.

Doctor feels I'd do well with ADR or Fusion.

Contemplating a law suit against insurance company for denial of ADR. Attorney is researching my information with outside doctors for expert witnesses if needed. Attorney feels it is most likely that the inscurance company would settle before going to court because a court case usually goes in favor of the individual and not the big insurance company. It would cost me about $5,000 to take it that far. More if it needs to go to court.

Considering fusion since they usually work out well at L5/S1 where not much mobility is affected. The posts from fusion patients have been helpful to me.

Brady
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15+ yrs chronic low back pain.
L5/S1 DDD
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  #2  
Old 06-26-2005, 04:15 PM
ans ans is offline
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Hey Brady,

This has been a loong struggle with you. Best of luck, Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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  #3  
Old 06-26-2005, 07:44 PM
Kim Kim is offline
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Brady good luck on what you decide. I have contacted an atty too and got much the same numbers and advice you did. My problem is I need a 2 level and the fusion is not so successful in that area plus I need more flexibility due to my profession.
Let me know if you decide to follow the litigation route. I would be interested to see what happens
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Kim
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
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  #4  
Old 06-27-2005, 05:20 PM
bmills bmills is offline
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Kim:

At this point, I really want to file the law suit. I have three very experienced ortho surgeons that have examined me multiple times and recommend ADR. Also, my attorney has two chiefs of surgery (one in Texas and one in Denver) that she had review my case and they both support ADR for me. I'd really like to know what the insurance company does when they see that in the law suit and know that all these docs would be expert witnesses if they choose not to settle out of court.

I will keep you posted.

Brady
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15+ yrs chronic low back pain.
L5/S1 DDD
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  #5  
Old 06-29-2005, 09:09 PM
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Harrison Harrison is offline
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Brady, thx for sharing your challenges. I say, GO GET THE BEANCOUNTERS! (Yes, I am shouting.)

They may not understand your case, your pain, your research, your journey towards a decision -- but they understand $.

Knock em dead in their boots.
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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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  #6  
Old 06-30-2005, 12:10 AM
bmills bmills is offline
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Thank you Allan, Kim, and Harrison and everyone else.

Also, thank you Andrea. Andrea is on this forum. She is here in Colorado and is in the legal/attorney business and has provided extremely valuable insight to me.

The attorney plans to file the complaint next week. I think its worth the $5K investment. They have to turn around eventually.

Brady
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15+ yrs chronic low back pain.
L5/S1 DDD
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  #7  
Old 06-30-2005, 09:57 AM
Rein Rein is offline
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OK, everyone else - Get up out of those painful chairs, walk over to the window, throw it open, stick your head out and shout, "WE'RE SICK AND TIRED AND WE'RE NOT GONNA TAKE IT ANY MORE!!!".

There, that felt better...

(Sometimes shouting's wicked appropriate. Huh, Rich?) ;-)
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03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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  #8  
Old 06-30-2005, 03:36 PM
ans ans is offline
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Brady, good luck w/this.

Hey, one day let's hike in Rocky Mtn. Nat. Park! Or hang on Larimer St. where Keruouac hung out (sorry, used to live there..).

Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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