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  #1  
Old 06-08-2007, 05:32 PM
LBP LBP is offline
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Okay everyone, this may be the time to email Oprah about our coverage issues. Oprah has a link asking for people to email her about our health insurance woes. See http://www.oprah.com/tows/pastshows/...070605_b.jhtml

She recently had Micheal Moore on her show to discuss his latest documentary "SICKO" where he takes the health insurance indus head on. I just saw part of the Oprah show and he had a few woman who were denied test and/or treatment because it was experimental etc....

So it made me think..if she gets enough of our stories...maybe ADR can get a little air time.
__________________
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
  #2  
Old 06-08-2007, 05:42 PM
LBP LBP is offline
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Harrison,

What if we had some sort of organized thoughtful submission to the Oprah show, discussing you, this forum, your connections, our desire for ADR and how so many people have to go out of the country to get the best available treatment, and of course the issue that bugs me the most...how FEHB forces private insurers to cover this procedure for fed employees because fed gov't plan's have determined an FDA approved device can no longer be "investigational and experimental" while private employed invdividuals have a never ending uphill battle to get coverage.

Maybe we could all "sign" something thoughtful that incorporates references to surgeons and/or spinal organizations, literature? What do you think. Is there a way to have as many people sign something via the forum?

of course I think personal stories submitted invidually are also compelling!
__________________
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
  #3  
Old 06-08-2007, 10:19 PM
ZorroSF ZorroSF is offline
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since we don't have exact facts regarding how many people have been pursuing ADR and how many people have been denied, I don't think this will make their 30 second sound bite. However, if you can submit ridiculously approved coverage as opposed to life saving disapproved coverage then they would probably be happy to hear from you.

For instance, Blue Shield of California will cover an individual receiving a Facial Cleaning (as long as the doctor knows the codes), but they won't cover an MRI.
__________________
***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
  #4  
Old 06-08-2007, 10:56 PM
LBP LBP is offline
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Did you see the story on Oprah? I'm not asking in general to send pleas to her...like others have before. This time it's an invitation by her to discuss the craziness of health care. Yes death cases will get more time, but If there is a large group mobilized....back injuries have a HUGE impact on the productivity of the work force! The prevelence of our issue alone should give it notice. Esp since so many of us would not be applying for disability, taking so much time off from work, or not
working at all because of back problems!

Plus don't you think some of the horror stories out of Stenum might get their attn for a number of reasons: 1, US citizens are being preyed on to get treatment at an undesirable facility because they cant get their ins co to pay for the service in our own country 2, now these patients are having a difficult time even finding a dr to touch them after having problems from a foreign surgery!

Then contrast those experiences with those with huge successes from local surgeons as well as the other Germany locations. Then point out the hypocrasy it is that companies like BCBS could deny most of their insureds coverage but be forced to pay for a fed employee with BCBS. That is arbitrary and bad faith in my mind and should be an issue raised.

Plus the crazy issue how fusion is a "gold standard" yet it's never undergone rigorous clinical trials that ADR has, plus the stats on non fusion and secondary surgeries for fusion is pretty dam high.

As stated by Medicare in it's decision memo regarding ADR policy:

"Millions of Americans suffer from pain-related problems (Salovey, Seiber et al. 1992). Low back pain is a common condition, with sixty to eighty percent of U.S. adults afflicted at some time during their life (U.S. Preventive Services Task Force 1996).
***
In general, the social and economic impact of chronic pain is enormous (Salovey, Seiber et al. 1992).

***

Fundamental problems plague the study of spinal fusion, including the lack of definitive methods to confirm a solid fusion, a weak association between solid fusion and pain relief, and the placebo effect of surgery for pain relief.” For patients, improvement in short term pain and function from fusion is unacceptably variable, and long term results remain controversial. In spite of the many difficulties and ambiguities, the use of spinal fusion surgery in the United States is rapidly increasing (Deyo, Nachemson 2004). "


All of our issues are important to the Oprah discussion opened up by Michael Moore's new documentary. Mr. Moore's issue is that it's a profit driven industry and that's why insurers are constantly denying coverage claiming things are "investigational and experimental" in spite of what our treaters are saying are absolutely necessary. He points out that we would never consider it reasonable for the fire dept to turn on profit on saving lives...why should our health care turn on huge profits to CEO's? There's no insurance company looking out for our best interest medically protecting us....it's all political and economics...and that is what part of this Oprah discussion is about.

PLEASE DON'T BE DISCOURAGE BY PREVIOUS ATTEMPTS TO GET ADR IN THE SPOTLIGHT. MICHAEL MOORE MAY HAVE JUST DONE US A HUGE FAVOR BY OPENING THE DOOR TO A DISCUSSION ON OPRAH BECASUE THIS DOCUMENTARY WILL LIKELY BE A HOT TOPIC IN THE UPCOMING ELECTIONS.

The short term cost of the disc is one hinderance in getting coverage over fusion. I could have been approved a 2 level fusion but not an ADR? How is that not a financially motivated denial!! The only difference between the two surgies is a vascular surgeon and the cost of the discs. If a treater recommends this surgery based on age, life style, career, kind of injury, etc...shouldn't the insurance company be forced to cover the procedure. That's the point.

When Mr. Moore was on Oprah, she specifically asked people to send comments after seeing his documentary (which is supposed to come out later this month). She had one of her "ah ha" moments about socializing medicine and want's to hear others comments and also experiences with the heath care system.
__________________
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
  #5  
Old 06-08-2007, 11:10 PM
ZorroSF ZorroSF is offline
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as a matter of fact, I saw the interview on Youtube. Only after you posted this thread. thanks for the heads up. It all looked liked 30 second sound bites. Of course they are correct in their assessment, but the interview seemed setup for the attention deficit disordered.

Sensationalism is what's she's looking for that's why we don't really stand a chance, unless of course, your insurance denied a spinal fusion or they refused to pay the hospital bill only after approving the surgery (which is my case). I think you do make a good point about federal workers being covered while the rest of the providers deny it.
__________________
***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
  #6  
Old 06-08-2007, 11:28 PM
LBP LBP is offline
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I actually think we might get some notice if we send it to Oprah and CC: Barack Obama and Michael Moore.
__________________
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
  #7  
Old 06-08-2007, 11:38 PM
LBP LBP is offline
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I also edited my previous post...what about the stenum folks. That might be enough of a shock factor to get the rest of our discussion reviewed.

The part I saw on TV had to do with a women who was denied a test to determine whether kemotherapy would be successful (denied because the test itself was considered investigational and experimental)

Another women was denied treatement for a brain tumor. She was out of the country and dx with a brain tumor and her US insurer denied she had a brain tumor.

There were 5 women in focus...a variety of Blue Cross people and a Cigna. A chunk of the show was interrupted due to a local plane crash into Lake Michigan, so I didn't see the whole segment.
__________________
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
  #8  
Old 06-09-2007, 06:35 AM
chasswen chasswen is offline
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lbp
didnt you know that the fda is a useless piece of federal government. NOT
i smell a class action lawsuit coming.
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
  #9  
Old 06-09-2007, 10:04 AM
ZorroSF ZorroSF is offline
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I think you might have a very good point there about forcing patients to seek medical tourism. The worst outcomes (paralysis, death, etc..) would really spark conversation.

why don't you draw up a letter concerning those points and we can all add our names and addresses to it. then you could email it in to that show?



Part 1 of the interview
http://www.youtube.com/watch?v=-U_RIK7OyuY

Part 2
http://www.youtube.com/watch?v=Icor2ILQtLw
__________________
***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
  #10  
Old 06-09-2007, 10:37 AM
Harrison's Avatar
Harrison Harrison is offline
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Thanks for the interesting discussion and ideas. I thought about sharing some of the interesting op-ed pieces I read on Michael Moore, but I couldn’t find the time to carefully articulate my views about this latest movie, and how our community might use it as a springboard for furthering our cause. That is to say, promoting awareness of the absurd insurance issues as well as medical tourism issues (there are many).

I’ll think carefully about what you’ve thoughtfully shared here, and send in my comments via the Oprah web site. If anyone here has contacts/phone #s for the producers, pls email or PM them to me so I can follow-up on my feedback.
__________________
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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
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