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  #1  
Old 03-22-2006, 10:12 PM
Eddie_G's Avatar
Eddie_G Eddie_G is offline
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so now I wait....and wait to see if Liberty Mutual WC will let me choose a doctor with signifigant experience( I'd say 100+ disc replacements is a nice round number) The IME doctor, Dr. Vaccaro has done 10 disc procedures. He prefers the Charite over the Maverick because of the keel (he called it the "fin". He also said to hold out as long as I can for the next generation discs to come out.
Any new rumors on that?
I can't wait any longer and would really like an operation in June and to be recovering in July & August. He also said to be wary of "cheerleader" doctors and to be careful to find the right doctor. Because he does the Charite, he recommended a Charite.
Will I have a problem if I want a Prodisc or Maverick?
Do insurance companies dismiss doctors based on the disc they do?
Liberty Mutuals WC "in-network" doctors have little ADR experience.
How hard is it to diplomaticly get ins. co's to go out of network?

My short list includes Dr. Hallett Mathews of Virginia, Dr. Yue of Connecticut, Dr. Bitan (although he does the Charite, he is the best Charite Dr. in NY) So I think this is good news because now I can put pressure on the ins co. to do something. I left Philadelphia very happy yesterday, especially after seeing the "Body Worlds" exhibit at the Franklin Institute of Science where they have cadavers sliced up into some kind of art/science project. I was able to look right inside people's bodys and see the spine, the nerves, the veins, the discs ect... on a close up scale that you couldn't imagine. If you ever get a chance to see this exhibit, it is amazing for a spiney to look at crossections of spines and backs.
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #2  
Old 03-22-2006, 10:55 PM
Mariaa Mariaa is offline
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Hey congrats on the IME approval! Hope you will get authorization for the surgery approved ultimately ~wherever..
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  #3  
Old 03-23-2006, 09:22 AM
JL JL is offline
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Hi Eddie, Great news. I know Dr. Yue performed the first Connecticut approved Workers Compensation ADR I think in 2002. This and your IME puts us one step ahead for sure. I suspect there is a difference between ADR IME's doctors and IME "fossils" doctors as someone recently described them. Good Luck.
__________________
(Bill) 14 yrs L5-S1 pain & tear
Discography 2003 DDD
10 yrs. chiropractic
6-14-05 L4/5 & L5/S1 Prodisc Yale New Haven CT Dr. James Yue
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  #4  
Old 03-23-2006, 05:57 PM
go*big*red go*big*red is offline
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Congrats, Eddie.

Let me be very frank in saying I'm SO JEALOUS! But, good for you! The more approved, the more they will approve.

I imagine (conjecture on my part) that the Maverick most definately will not be one they would approve because it's just done with the trials. The prodisc people train their own drs. first (the ones that use the hardware supplied by the prodisc mfr) and then others after so, depending on the dr. it could be a while for that one as well.
__________________
Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #5  
Old 03-28-2006, 05:47 PM
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Eddie_G Eddie_G is offline
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OK Now comes the monkey wrench...

Liberty Mutual will not let me go outside of the state of NJ for this procedure. NJ docs have no experience in ADR yet they are keeping me in state. I felt like a guinea pig so I called my lawyer.

My Lawyer said that they have done everything I have asked for thus far. The insurance co. is only required to provide reasonable treatment. Not GREAT treatment, just reasonable treatment...NJ treatment too. They don't have to buy me a Rolls Royce when a Ford will get me from point A to point B. They are going to give me a list and I'll have to choose my poison. I sure hope there are some good Prodisc or Mav doctors here in NJ. Charite seems to be the standard in NJ but if I'm getting a Charite, I would be nuts to go to anyone else but Bitan. I really want Dr. Yue now since the Prodisc is close to tier 1 and I can get that this summer hopefully.

I think I need to push my lawyer more but I'm really not sure what to do at this point. Should I pay my lawyer to shake things up?(I haven't paid him a cent yet) How do I, as a WC patient, get them to go "out of network"?

I am still waiting for my GPS profile to be looked at by some good Dr.'s so I'm going to wait for more opinions but not much longer...
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #6  
Old 03-30-2006, 02:50 PM
wbaker68 wbaker68 is offline
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I would recommend getting cost analysis to show that the tx would cost the same either place you go and that you will just have to be responsible for providing your own transportation and lodging should you wish to not come home as soon. We have comp. here in DE allow out of statement tx all the time, but as we all know, comp. is entirely different in just about every state.

Good luck.

Bill
__________________
Spinal Cord Stimulator Implant 6/11/03; Discetomy 12/89; L3-S1(3 level) ADR, August 7th, 2004 by Bertagnoli in Vienna, Austria.

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  #7  
Old 04-19-2006, 12:10 PM
Eddie_G's Avatar
Eddie_G Eddie_G is offline
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Today I got a call, after going over EVERYONE'S head, from my company's medical director. He agreed that I should see a Dr. with signifigant ADR experience. The best Dr. in Liberty Mutual's network is Dr. Jeff Goldstein of Seaport Orthopaedic Associates NY. They normally don't take out of state patients but the ball is in my company's court now. The doctors that they originally authorized me for had:

Dr. Ben-Yeshay - ZERO disks (how insulting!)
Dr. Bhatnager - ONE disk (how rude!)
Dr. Vaccaro - TEN disks (eh.)

Dr. Goldstein has implanted over 70 Prodiscs and about 50 Charites. I have been researching this for over 2 1/2 years and found it insulting that they would send me to a Dr. with NO experience at all. I know who is good and I know who is great. Goldstein is good and has alot of experience which is VERY important. His greatness is yet to be determined.
My medical director had a pow-wow with Liberty Mutuals medical director and.....

I GOT MY APPROVAL FOR DR GOLDSTEIN about an hour ago and I'm so happy I want to run through the halls naked!!! I'm getting my life back folks and I'm looking forward to my first discogram

Be a squeaky wheel and you'll get greased. I went through HELL trying to get him!

PRODISC HERE I COME!!! (or Charite) But I think Prodisc will be approved soon so I'd rather have that one.

WHOOOOHOOOOOOOOO!!!!!!! HAPPY DAY!!!!!! I GOT MY DOCTOR! I GOT MY DOCTOR! I GOT MY DOCTOR!
*rips off clothes and runs through halls*
WHOOOHOOO!!!!! YIPPY!!!!!YAAHHHOOOOOOO!!!!!!
THANK YOU JESUS!!!!!! YAY!!!!!!!!!
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #8  
Old 04-19-2006, 01:19 PM
Justin Justin is offline
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Congrats! Run through the halls naked my man...

Justin
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  #9  
Old 04-19-2006, 01:38 PM
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Thanks for putting a smile on my face thru your excitement. And I can relate to your eagerness to have a discogram, even though you know it can be painful. That will be an important step as you head toward surgery. Way to go, way to persist! Keep us informed.
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  #10  
Old 04-19-2006, 10:42 PM
Kim Kim is offline
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GOOD FOR YOU!!!!
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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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