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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
08-18-2005, 01:24 AM
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Hi. I was authorized by Empire BC/BS of NY (Empire Health Plan) for a two-level ADR. However, in the fine print, the authorization says that the surgery could be held to subsequent review.
 Dr. Regan's office who seemed familiar w/this insurance said that they very well could deny payment, despite authorization. Has anyone ever heard of this caveat? If so, I guess one gets the surgery and tries the appeal route. Best, 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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#4
08-18-2005, 09:12 AM
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ans~
When did you receive this authorization? It seems like a case of insurance CYA to say it's authorized and in the same breath say it could be held to subsequent review. Have you spoken with the insurance co to determine if it means what it says? Would you get this procedure done if you knew for certain it would be paid for?
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#5
08-18-2005, 10:38 AM
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Thanks Mark.
Mariaa, I recieved this authorization in late March, 2005. The insurance company is tight-lipped and said that they have the right to hold the authorization for review - that's it. I would have surgery if my back pain declines - which it is, or if I have an urgent need. Still, it's unsettling b/c I don't have the means to pay for a two-level out-of-pocket. 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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#6
08-18-2005, 10:41 AM
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Not that it helps any, but pretty much my dilemma as well (although I *seriously* doubt UHC would approve me for a two level ADR right now).
My thinking is that my best option is to try and hold on for a few (best guess / estimate on my part) more months for prodisc approval and then run with that... David
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47 years old Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.) L4-S1: Prodisc
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#7
08-18-2005, 11:28 AM
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David, I'm thinking the same thing: do it when ADR is more standard. I'd have to live underneath a subway if I paid out-of-pocket for a two-level (well, interesting story). Thanks for advice. Wonder if you'd qualify for an Prodisc vs. Charite trial if you're willing to take this chance. Best, 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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#8
08-18-2005, 12:07 PM
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Studies:
Good question. Possibly. It is conceivably possible that I might qualify for the Activ-L study as well (as I note on Dr. Y's website) Prodsic versus Charite: I am leaning more towards Prodisc instead of Charite, but I pretty much agree with what Mark says: The type of implant is generally less important than the skill / experience of the surgeon and the placement of the implant. David
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47 years old Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.) L4-S1: Prodisc
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#9
08-18-2005, 07:07 PM
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Hmm guys what studies are you talking about? I have been looking for studies and have not been able to find anything actively recruiting right now for more than one level. If you can point me in the right direction I would be grateful!
Kim
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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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#10
08-18-2005, 08:10 PM
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I can't find a centralized location for this info. Bummed that my DDD excludes me from trials.
The hard way (sorry, TinyUrl site down): http://www.google.com/search?hl=en&l...al&btnG=Search
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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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