Upcoming Prestige ST at C6/C7

[thumoeides]

New member introduction.

On January 15 I had severe left shoulder pain. My GP first diagnosed bursitis, gave me prednisone and muscle relaxents. No improvement one week later and GP referred me to a physical therapist. Two weeks later with no improvement I asked for a referal to an orthopedic surgeon who ordered X-ray of my shoulder and MRI of my shoulder and neck as I reported shooting pains down my left arm. He also gave me a steroid shot to the shoulder.

He referred me to a neurosurgeon when he saw the MRI which indicated degenerative disc disease. The neurosurgeon said I need immediate anterior discectomy and fusion of C5-C6 and C6-C7. He noticed weakness in the left arm and lack of triceps reflex. But he said I could wait another two weeks and gave me 30% chance of recovery with more prednisone and perscription naproxen.

I went to a second neurosurgeon for a second opinion who said I should try two more weeks of physical therapy and ordered a CT scan of the cervical spine because the MRI was not clear on C6-C7 herniation. He said I had a detectible reflex in my left triceps.

Physical therapy helped with severe shoulder pain. Can avoid pain if I keep my head down, but left arm pain and shoulder pain return if I lift my head up or bend it back.

Saw second neurosurgeon for again in two and a half weeks time. He said surgery was necessary. No triceps reflex. He said either two level discectomy and fusion, or single level disc replacement. Since C5-C6 seems to be asymptomatic, although future surgery at that level might be necessary, he said the disc replacement at one level made sense. Although both options could lead to good results, if it were him he would choose disc replacement.

Medtronic, the maker of the Prestige disc, would use Therapy Access Solutions to prepare the request for predetermination for the Prestige disc to Blue Cross Blue Shield of Texas.

Request letter and supporting documents were faxed to BCBS on 3/26. It has now been three weeks with no decision.

I am wondering what an average wait time for a decision is. I have called both Therapy Access Solutions and BCBS several times and been told a decision should come in the next few days, but no guarantees.

I am thinking of calling my surgeon and asking him to call BCBS to say the surgery is urgent because the longer the wait time the worse my chances of full recovery of muscle use are.

Any advice?

[ajj1001]

Welcome to the forum, unfortunately I'm have lumbar problems and am in the UK so can't help with your questions. Sure someone will soon.

alison x

[Cindylou]

Yes, under the circumstances, I would utilize any and all powers of persuasion, including your doctor. When I was trying to get my insurance provider to approve a cervical rhizotomy last fall, I went thru 3 appeals and denials. Then, one day my pain management doc decided to just call them personally and explain my situation, and he got an immediate yes! Go for it! Oh, and welcome to SPS, by the way.

[thumoeides]

Thanks for the advice and welcome.

The problem is I have yet to get a denial, so I cannot mount an appeal.

I have talked with the woman who prepared the predetermination letter signed by my doctor. She works for Therapy Solutions, which is hired by Prestige which makes the artificial disc. She says BCBS can take up to 21 business days, and that they will not be influenced to move more quickly except by a life threatening condition. She says she has recieved many approvals from BCBS and none have taken longer than 21 business days.

Perhaps she is wrong and my doctor can have some influence.

[Cindylou]

I would still ask your doctor to call and try and "push things along." It can't hurt, and it could just possibly get the ball rolling faster! One slight correction on my part: altho I have had cervical rhizotomy, in this case last fall, it was for lumbar rhizotomy. Hope you get some answers and solutions soon. Good luck.

[thumoeides]

I have taken your advice. I called my doctor this afternoon. We'll see if he is willing to act, and if he does whether it makes a difference.

Thanks for your advice.

[Justin]

thumoeides,

Welcome to the Spine Patient Society. Keep us posted on what you find out from your doctor.

[thumoeides]

I found out Friday I have approval by the insurance company, and Saturday I got a call from the hospital for preregistration for surgery on May 6.

When I called the insurance company Friday I was told the approval had come through Wednesday and they had mailed my doctor and me letters. I asked why they hadn't faxed my doctor and was told they only do that if the surgery is urgent.

For those curious, my request for predetermination was made on March 29, and the approval was given on April 20.

The hospital says the surgery, without insurance, would cost $33,353.59. I said I thought $33,353.60 made more sense.

The surgery will be cervical arthroplasty at C6/C7.

My question now is whether I should see the surgeon prior to the surgery in two weeks.

[Justin]

I found out Friday I have approval by the insurance company, and Saturday I got a call from the hospital for preregistration for surgery on May 6.

When I called the insurance company Friday I was told the approval had come through Wednesday and they had mailed my doctor and me letters. I asked why they hadn't faxed my doctor and was told they only do that if the surgery is urgent.

For those curious, my request for predetermination was made on March 29, and the approval was given on April 20.

The hospital says the surgery, without insurance, would cost $33,353.59. I said I thought $33,353.60 made more sense.

The surgery will be cervical arthroplasty at C6/C7.

My question now is whether I should see the surgeon prior to the surgery in two weeks.

Congrats on the approval! A pre-operative appointment would be helpful in terms of post-operative care instructions and any outstanding pre-operative tests that need to be performed.