Thoughts -- Spinal Fusion Denied by Insurance (Final Appeal Denied)

[bigdogchief76]

So, my final appeal for benefits regarding fusion was denied. Insurance company upheld original ruling.

I've mentioned this before, and as crazy as it might seem, they will provide benefits to me for a total disc replacement, as long as the ADs are FDA approved. I already have an appointment to meet the ortho surgeon that is doing the TDR here in Wichita. I'm trying to move the appointment from the 14th of Feb to something sooner (I'm on a cancellation waiting list)

I guess, I would love to hear feedback from all of you prior ADR patients.

1) Pain after surgery related to the back problem: Increase in pain, decrease in pain, about the same?
2) Recovery time?
3) Return to work time?
4) Emotional & mental recovery?
5) Required care-giver assistance?

ADR is what I have left in regards to options. It seems like a backwards world where ADR is being approved and fusion is not. However with my condition, I can see both sides of the issue.

Fire away folks...

MB

[Hooch]

Must be a lot of hands being greased to hold such a disgraceful 'health' system together over there.

ADR is the much better op to undergo.. if you are indicated. Much quicker recovery, better outcomes.

Retrolisthesis.. you may not be.. depends on the condition of your posterior elements. If your spine is stable, and you are offered adr over fusion, and are ready for the op.. go for it. Just make sure your surgeon has plenty of experience, placement is vital.

If you aren't adr candidate, does anyone have any luck getting a lawyer and taking the bastards to court?

Good luck.

[bigdogchief76]

Retrolisthesis.. you may not be.. depends on the condition of your posterior elements. If your spine is stable, and you are offered adr over fusion, and are ready for the op.. go for it.

My retrolisthesis is not severe enough to warrant instability. In fact, I have a very stable back. I just happen to have a blown tire between the L5-S1 area. The rest of the discs are good to go.

....does anyone have any luck getting a lawyer and taking the bastards to court?

Not enough money it in for the sharks. Nor do I have the time or pain endurance to go much longer with this. If the bloody insurance company wants to pay for the TDR then I will stick it to them.

Thanks for the info. Will keep everyone informed...

MB

[KBear]

Sorry Matt, that sucks. That is absurd that they will pay for ADR and not fusion, when for years it's been the opposite. I've never had a fusion, so speak from what I've read and heard. My understanding is that fusion is a much harder recovery than ADR. Not sure all the reasons why though.... maybe because you have to have a solid fusion before resuming many activities, may also be more invasive (though I might be full of it too... LOL) I wouldn't rule out ADR and if that's what they want to pay for, and you are a candidate, why not? Best of luck.

[Justin]

So, my final appeal for benefits regarding fusion was denied. Insurance company upheld original ruling.

1) Pain after surgery related to the back problem: Increase in pain, decrease in pain, about the same?

1) Sharp increase in pain immediately post-op.

2) Recovery time?

2) 4.5 months post-op pain-free, mowing the yard, etc.

3) Return to work time?

3) Luckily, I started back to work ~ year post-op.

4) Emotional & mental recovery?

4) Emotional recovery always takes much longer than physical recovery, IMO.

5) Required care-giver assistance?

5) My wife assisted me greatly before and after my 2-level disc replacement operation, as I was bedridden for a year before my operation.

ADR is what I have left in regards to options. It seems like a backwards world where ADR is being approved and fusion is not. However with my condition, I can see both sides of the issue.

Fire away folks...

It is really backwards that the gold standard of spine surgery for the last ~50 years was denied.

[Cindylou]

Justin and the others covered most of the territory Matt. I will only add from my own personal experience, that my ADR surgery felt way more invasive and painful than my fusion surgery. Again, could be just me. Of course, I also had 3 lumbar discs installed, so no picnic. I think it might be time to start preparing for ADR surgery on your L5-S1. Good luck Matt and keep us posted! Cindylou

[KanRunMo]

Congrats on being accepted for TDR/ADR. Insurance coverage is usually reverse of what you're getting with fusion being approved and not ADR.
Most of the more recent blogs on here indicate that TDR has a shorter recovery than fusion and lasts longer.
Surgery on Valentine's Day - Sweet!

[bigdogchief76]

Clinic called and confirmed appointment is still on to meet with Dr. Whitaker on the 14th @ 1500 CST

A legion of thoughts and emotions as this appointment is drawing nearer.

My hope is that I'm a perfect candidate for ADR and that Dr. Whitaker will not require me to go through any more tests. Then hopefully his schedule and the vascular surgeon's schedule are not overly busy and a surgery date can be quickly given. THEN, the final, largest piece of the puzzle, the pre-certification through insurance will be as smooth as a baby's butt. I don't think all of those things are asking too much, are they???

[Gilbert P]

Hi Matt

This sounds great I wish you the very best

keep moving forward

Gil

[KBear]

Saying a prayer for you!