Scared, sad, looking for advice

[atxmom]

I have read many posts on here in the past but this is my first post. Background info: 38 year old female, with several cervical protrusions due to trauma.

Most of my injuries were from a car accident in 2008, I was hit on the rear/side and then pushed into a fire hydrant. I had just started working a new job at time and did not have comprehensive health insurance and could not afford to have surgery. I have not been able to work full time since then due to chronic pain. This past February I was rear ended which compounded my injuries.

Fortunately, I was able to obtain traditional BCBS TX insurance recently.

Unfortunately, at my consult today I was told I needed a multilevel surgery (I was expecting that, but thought I would only need 2 levels). I was told today the only option for me that would be covered by insurance is fusion at 3 levels. I was hopeful that I would be able to have a hybrid procedure but my surgeon said hybrids is not covered by insurance. I know that some companies will approve ADR/ADLF, so I am confused. I don't know if the difference is because I need 3 levels instead of 2 or if it's because mine is cervical.

If anyone has had any experience with this type of surgery, I would love to any info.

[drewrad]

Originally Posted by atxmom

I have read many posts on here in the past but this is my first post. Background info: 38 year old female, with several cervical protrusions due to trauma.

Most of my injuries were from a car accident in 2008, I was hit on the rear/side and then pushed into a fire hydrant. I had just started working a new job at time and did not have comprehensive health insurance and could not afford to have surgery. I have not been able to work full time since then due to chronic pain. This past February I was rear ended which compounded my injuries.

Fortunately, I was able to obtain traditional BCBS TX insurance recently.

Unfortunately, at my consult today I was told I needed a multilevel surgery (I was expecting that, but thought I would only need 2 levels). I was told today the only option for me that would be covered by insurance is fusion at 3 levels. I was hopeful that I would be able to have a hybrid procedure but my surgeon said hybrids is not covered by insurance. I know that some companies will approve ADR/ADLF, so I am confused. I don't know if the difference is because I need 3 levels instead of 2 or if it's because mine is cervical.

If anyone has had any experience with this type of surgery, I would love to any info.

2nd opinions and 3rds. Maybe even a 4th. You better get them going now though, then compare notes and see who comes out on top.

[NJ Gene]

Dear ATX,

Based on your name and insurance, I am assuming you're in Texas. One of the best places I'm told for ADR in the U.S. and other treatments, is the Texas Back Institute in Plano. I've heard mostly positive outcomes from people on these boards who have dealt with them. I've also heard that they help you go through the insurance process when requiring ADR surgery.

My sister and brother-in-law live in TX near Plano. They both use TBI for back issues and are very pleased with them. Perhaps with their help (TBI's) they can work with your insurance to allow a hybrid approach (ADR on a level or two and fusion on the other).

You can always look to Europe for ADR surgeons who use the M6 disc (considered one of the best out there). However, with three levels, you are looking at least $50K, not including travel costs. It's highly unlikely that insurance will cover any of it. Also, if you go to Europe there is no accountability. It's next to impossible to see a doctor in the U.S. for follow-up if you've had surgery in Europe.

The bottom line is that you need multiple opinions. Since you're in TX, TBI should be one of them.

Good Luck!!
Gene

[Kelly4ADR]

Sorry to hear about your neck! The process in the beginning can be scary but the more info you can gather the better. I agree with Drew, get more opinions. You can even send your films to the experts overseas for free and they will give you their opinion. Dr. Clavel and ADR. Bierstedt did this for me.

I also agree with Gene that TBI is a leading clinic.

To my knowledge, insurance doesn't cover hybrid, but that could be MY insurance and MY geographic area, both which matter. Also, just remember hat fusion has helped many people and if that ends up being your option for financial reasons or whatever, don't rule it out.

Hope this helps

[atxmom]

My surgeon is at TBI. I actually spoke with 2 of them at my appointment. I know what I need to do, get more opinions, research, etc. but the journey to even getting to this point has drained me. I've been holding on to the fact that I could finally have a surgery soon to keep me moving forward the past few months. Now after this appointment, I feel so emotional. Like I don't Have any fight left, I'm just overwhelmed.

They told me that right now the priority is not pain management but to preserve my spinal cord. That really I need to be looking at surgery within the next weeks, no longer than that. There isn't anything protecting my spinal cord right now and a small accident like falling of a ladder or slip & fall could be catastrophic for me. I'm also under the clock because I will only have a limited amount of time with this insurance.

At my first appointment at TBI I had a time convincing them that taking a dose pak of predinisone and naproxen for two weeks wouldn't really help me and MRI couldn't wait. Now I'm told surgery can't wait & good chance I will have an increase of pain afterwards, and possibility that the fusion could further compromise my C6-7 which is already herniated but cord is preserved.

[atxmom]

My father has had several back surgeries and lived with back pain most of his life. When he heard "fusion" he cried, he would rather I take my chances of leaving this alone rather than having fusion.

I'm not trying to base my treatment on the cheapest option. But I have child who's needs come first. I am a single parent and have not been able to work full time since my accident, most of my savings have been depleted supporting us. I simply can't afford anything other than fusion. My retired parents, who don't have a lot of money either because they have had to deal with my dad's surgeries since I was a teen, are willing to mortgage their house to pay for an alternative. I'm don't know that I'm really willing to do this to them though.

I don't feel that TBI will be all that helpful with trying to get approval from insurance. My experience with them so far has been that I'm on my own and I need to pay them upfront and then I need to get it from the insurance myself. I've already had several issues with their billing office.

[hobbes1212]

Why do they think you will likely have an increase in pain after surgery?

[atxmom]

Originally Posted by hobbes1212

Why do they think you will likely have an increase in pain after surgery?

They said there was no guarantee that the surgery (ADR or fusion) would relieve my current pain. There is also protrusion on C6-67 that is not part of the fusion. Additional pressure on this disc from fusing 3 levels above could cause pain. There would also be stiffness from multilevel fusion.

[drewrad]

My own personal experience at TBI was poor. I reached out to them probably on four separate occasions. I also sent them physical copies of my MRIs and their patient packet which they lost. They NEVER got back to me at all. I finally just gave up on them.

[atxmom]

Originally Posted by drewrad

My own personal experience at TBI was poor. I reached out to them probably on four separate occasions. I also sent them physical copies of my MRIs and their patient packet which they lost. They NEVER got back to me at all. I finally just gave up on them.

That's unfortunate that happened. I think if you can get pass the business side of it TBI offers great care to their patients. Even though I had to push a little in the beginning to get them to realize what shape I was in, after my MRI came in it was completely different. I love the dr (non surgeon) that I worked with and the dr who did my nerve testing was great. My surgery consult was a little rushed because they were late (I waited an hour & half before they got there). But they sent in a different surgeon to talk to me first, since my surgeon was somewhere else.

Any of my complaints about them would be about the office. I cancelled my 1st appointment because I got so annoyed with them not listening to me and assuming they knew the answer. They had called me 6 times about the same problem and asked me questions that I answered 30 secs before. I already have billing issues with them. Other than that, I'm glad that I went there.