HELP !! Trying to find good Surgeon in Washington DC area that will also get ASR approved by CareFirst BC BS

[mccauleyjw]

Good day to all,

I saw a Neurologist in October 2010, for numbness in left arm and weak left tricep. An MRI was ordered along with EMG testing. MRI reported the following findings: Discogenic disease, resulting in central canal and bilateral neural foraminal narrowing at C5-C6 and central canal and left neural foraminal narrowing at C6-C7. Findings at C6-C7 may account for patient's left-sided radicular symptoms. EMG tests support MRI finding.

Saw Dr. Charles J. Riedel, Neurosurgeon, Arlington Virginia in March 2011. Dr. Riedel recommended Anterior Cervical Discectomy and Fusion (ACDF) of the C-6 and C-7 or Cervical Artificial Disc Replacement. I have been informed that he has done many ACDFs, but only 10 to 20 Cervical Artificial Disc replacements. I would like to have an Cervical Artificial Disc Replacement. I do not want ACDF or any type of fusion. However, CareFirst BlueCross Blueshield states that Cervical Artificial Disc Replacement (procedure code 22856) is still considered experimental at not covered. Dr. Riedel's staff is not willing to assist me in getting CareFirst BC/BS to approve a Cervical Artificial Disc Replacement, stating that ACDF fusion is my only choice.

I am seeking a good surgeon in the Alexandria/Washington DC area that is "Pro" Cervical Artificial Disc Replacement that will also assist in getting the procedure covered by my health insurance.

Thanks,

John

[spinches]

John, does your insurance company let you use doctors who practice in other states? That would expand your options considerably.

Sandra

[mccauleyjw]

Hi Sandra,

I am not 100% sure if CareFirst will let me use doctors from another state. I think they will with additional "Out of Network" charges. My current "In Network" has doctors in Virginia, Maryland and Washington DC. So, I would assume that they would.

Regardless of where the doctor is located, I still need a doctor that can convince CareFirst that Cervical Artificial Disc Replacement is a medical necessity for they still consider the procedure "experimental". However, it is something to consider to expand options if needed.

Thank you for a good tip.

John