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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 08-19-2008, 10:23 AM
ans ans is offline
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I was privately told this by a smart board member but it's hard for me to tell from searching online and of course, I can't find the Search function here.

Specifically, I wonder if the Kaiser's CA Risk Pool would cover this. I feel like I need insider's information on this. I guess the next question is who there is very competent.

But one step at a time.

Thanks and be well. - ans
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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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  #2  
Old 08-21-2008, 05:07 PM
LBP LBP is offline
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Well I thought Kaiser was listed on Charite's website for positive insurance coverage???

Also the search feature is the "FIND" tab.

The big question might be..who are the surgeons at Kaiser doing the surgery. I don't recall anyone naming a Kaiser surgeon doing ADR! How much experience do they have?
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Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #3  
Old 08-21-2008, 05:19 PM
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Harrison Harrison is offline
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Grasshopper, SEARCH and your will FIND. Or, FIND and you will SEARCH.

This is from an old press release from Depuy:

CIGNA, which provides health insurance to about 47 million people, joins Aetna, Kaiser Permanente, Horizon Blue Cross Blue Shield and dozens of regional insurers, in covering the surgical implantation of the CHARITÉ Disc for low back pain and disability from degenerative disc disease.

July 25, 2007

http://www.depuyspine.com/about/about.press.072507.asp
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #4  
Old 08-22-2008, 06:57 AM
ans ans is offline
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Duh, oh, the "Find" feature! Sorry!

Thank you both for your help.

My luck would have a one surgeon who I'd have to use who's done three ADRs.

Wonder if they cover ProDisc. Maybe Dr. Bertanogli or Zeegers would use me as a patient where he'd demonstrate before other doctors. Yes, I'll count on that.
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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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  #5  
Old 08-22-2008, 08:41 PM
Jessica Jessica is offline
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I have heard this from Kaiser Surgeons over the last few years.

In May 2006, I was told that Kaiser was "referring people to outside Dr's for Lumbar ADR, not for cervical yet".

In March 2007, I was told that Kaiser Oakland had just done their first cervical ADR in February 2007.

So, I would think they would have done several Lumbar ADRs by the time they got around to doing cervical. I don't know which device they are using or which of their surgeons has the most experience.
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Jessica 39 yrs old
10/2005 MVA C5-C6 herniation w/ cord impingement/displacement Unable to work full time.
July 31, 2006 Surgery successfully completed Prodisc-C C5/C6 on in Straubing, Germany by Dr. Bertagnoli. Able to work full time since 1 month post op, but some pain remains.
10/2008 3 surgeons confirm C6/C7 needs ADR and always has.
Has anyone had a second ADR surgery on an adjacent level?
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  #6  
Old 08-24-2008, 04:13 PM
ans ans is offline
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Thank you Jessica.

I"m sorry that you are unable to work and I hope that your nerve impingement gets better.

I guess nobody knows if my facets are too far gone but this is an interesting option to pursue. Of course my luck would to have a guy do his second surgery and have a sneezing fit while he's placing the ADR.

Best, ans
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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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Old 09-16-2008, 02:44 PM
brentmcd brentmcd is offline
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I'm in San Diego and have met with Dr. Daniel Green at Kaiser who does ADR surgery and actually had a Cherite and a ProDisc in his office to show me. I've talked with a few other spine surgeons since then, and they all seem to speak well of Dr. Green. I don't know how many procedures he has done though. Supposedly Kaiser will only approve a 1-level replacement, and unfortunately I've been told that I need a 2-level procedure.
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engineer for state dept. of transportation
former surfer, soccer player, mtn. biker, golfer, etc.
severely degenerative discs at L4/L5 & L5/S1
was potential ADR recipient; insurance would not cover
2-level (L4/L5 & L5/S1) fusion surgery on march 27, 2009
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  #8  
Old 09-20-2008, 02:18 PM
ans ans is offline
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Brent: Maybe you could have a fusion at L5-S1 and an ADR at the other level - bearing in mind the risks at L4-L5. Sorry you're in this situation as I can see you were once an athlete. Thanks/be well. - ans
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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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  #9  
Old 02-03-2009, 12:07 AM
graphicsliz graphicsliz is offline
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Default brentmcd

Can you please tell me where Dr. Green is located? I've been looking and so far cannot find what office he works out of. I need to consult with Kaiser re: ADR/Fusion in next two months. Thank you very much, liz
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  #10  
Old 03-24-2009, 01:20 AM
racheleddie racheleddie is offline
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Default Dr Greene

Dr Greene is at the Zion hospital medical offices. I am currently seeing Dr. Flippin in that office and happened to notice that Dr. Greene is in the same office. I've heard many, many good things about Dr. Flippin as well, so you may want to consider him as a Kaiser spinal dr as well. I will be having ADR surgery sometime in thenext 4-5 months, as that is how long it takes to get a surgery appt, although I am fighting hard and being the squeky wheel so hopefully yhey will move my surgery date up sooner! Best of luck to you! Let me know if you need the number...I can look it up for you.
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Karla
Age 47
Constant Back Pain since Jan 2008
PT, Traction, MRIs, CT Scan, Epidural Injections, Discogram
Herniated disc at L4-L5, spinal stenosis
Slight DDD and bulging discs at T6-8
Surgery June 12, 2009 - Scheduled for ADR, ended up with Fusion
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