I thought I was there, need help

[JRS11]

Hello all..well I was going to post when I got the approval for my XStop surgery, but the insurance turned it down today because as they say, it is "Investigational". Now I know it is not, the EMG, the Catscan, the Blocks I received were both diagnostic and investigational to see if this FDA approved surgical procedure was indicated, and it is. So I have to do battle with the insurance company, maybe go to the insurance commission in my state. What I need are some good articles, studies, etc. that I have not been able to find. I have some but I need a bit more science and I need a medical person, not someone with a BA to make a medical decision at the insurance company. So tomorrow I start calling. Any help would be great...

My condition, some of you may remember, my back is a mess, no fusing etc. because the doctors are all scared of what they may start as far as different levels being effected...the issue is spinal stenosis, sciatica (radicular pain) that I have had off and on for 12 years that has gotten much worse in the past year. The blocks have helped but they are not something I can continue to repeat as I would need to for them to be useful to keep me relatively pain free. Foraminotomy is one option but then there is the issue of scarring which I would rather avoid if possible. Lyrica is not something I want to be involved with. Any ideas?

Thanks

JRS

[KanRunMo]

You probably have either done the X-Stop spacer or given up on it. When I sent my MRI to Texas Back Center, they suggested the X-Stop. I did not have it done because I have multiple DDD and currently have no spinal stenosis pain and figured the X-Stop would not solve my problems. My insurance seemed to be going to pay for it. Maybe if you tell your insurance company that you will have to have fusion or and ADR if they don't pay for the X-Stop, they will come around. I'm would think the X-Stop surgery is less expensive than either fusion or ADR since it is less invasive.

[Cindylou]

Hello all..well I was going to post when I got the approval for my XStop surgery, but the insurance turned it down today because as they say, it is "Investigational". Now I know it is not, the EMG, the Catscan, the Blocks I received were both diagnostic and investigational to see if this FDA approved surgical procedure was indicated, and it is. So I have to do battle with the insurance company, maybe go to the insurance commission in my state. What I need are some good articles, studies, etc. that I have not been able to find. I have some but I need a bit more science and I need a medical person, not someone with a BA to make a medical decision at the insurance company. So tomorrow I start calling. Any help would be great...

My condition, some of you may remember, my back is a mess, no fusing etc. because the doctors are all scared of what they may start as far as different levels being effected...the issue is spinal stenosis, sciatica (radicular pain) that I have had off and on for 12 years that has gotten much worse in the past year. The blocks have helped but they are not something I can continue to repeat as I would need to for them to be useful to keep me relatively pain free. Foraminotomy is one option but then there is the issue of scarring which I would rather avoid if possible. Lyrica is not something I want to be involved with. Any ideas?

Thanks

JRS

JRS, sorry for the crummy news from your health insurance provider. That just sucks. I would venture to say that "the investigational" part your insurance is referring to is not all the testing you had done leading up to this potential surgery....it is the procedure itself, the X-Stop, that they are referring to as being "investigational." I just wanted to clarify that for you, as you move forward with your appeal. Also, scarring is typically never avoided, any time someone goes under the knife. What is more in question is, how much scar tissue will your body develop? A little? A lot? Every person's body reacts/responds differently to surgical intervention, just fyi. I'm not much help on the scientific studies, but hopefully, someone who knows more on that subject will chime in soon. Good luck! Cindylou

[JRS11]

You probably have either done the X-Stop spacer or given up on it. When I sent my MRI to Texas Back Center, they suggested the X-Stop. I did not have it done because I have multiple DDD and currently have no spinal stenosis pain and figured the X-Stop would not solve my problems. My insurance seemed to be going to pay for it. Maybe if you tell your insurance company that you will have to have fusion or and ADR if they don't pay for the X-Stop, they will come around. I'm would think the X-Stop surgery is less expensive than either fusion or ADR since it is less invasive.

It is cheaper, considerably. Just sent a letter to the Mass Insurance Commission, doc at Yale said he would not be able to impact them, either he has tried before or not interested in trying, I believe he would if he could.....

[JRS11]

Thanks Cindylou

[KanRunMo]

You may have been to the Xstop website, but there are lots of testimonials there and their main testimonial video is from Lee Trevino, the pro golfer. He claimed he was down to almost not walking at all and in constant pain. He had an XStop and is back to golfing with no pain. When the Texas Back Institute called me to tell me they would perform the X-Stop on me, they said they had recently done it on one of their surgeon's wives and she and her husband were both very happy with it. It definitely is not an investigational or experimental procedure. It has been done many times. There are some other similar devices to the X-Stop. It is minimal surgery which inserts the device into the back to lift the vertebrae off the nerve. It may not solve all your problems but it should solve the sciatica where it is inserted.