Aetna Insurance Denial: treatment of degenerative disc disease with spinal fusion "experimental"

[rgutshall]

Aetna considers fusion for DDD experimental... you have to have I believe grade III spondylolisthesis even, to have fusion approved.

They probably would have not ended up covering a 2 level ADR in the US, since the Prodisc is not FDA approved for such. If you check their policy guidelines, they do state this.

Part of the reason I went overseas... fusion scared me b/c of my SI joints and age anyway. Probably turned out for the best in my case.

Have you consulted w/ Boeree, Clavel, Pimenta, etc???

I know that they consider it experimental. My surgeon and surgical study consultant went through all my records and I fit each of the four criteria that they were asking for. Aetna did approve a two level ADR for me two years ago. I had the surgery done in May of 2010. We were actually very surprised that they did end up approving both levels. We were VERY surprised when they denied the fusion after approving and allowing me to have the ADR done. However, the ADR was apparently not the best option for me. It allows for to much movement preservation. Because of the movement, I have severe inflammation around the surgical area and all the over to my left side and down my left buttock and leg. I swell horribly around that area and it has caused me to lose 100% mobility in my left leg. I use a walker when at home and a wheelchair when I go out. I do have two places that are being pinched as far as nerve damage goes. Unfortunately, they are confident that my nerve damage is nearly permanent.

I have thought about going outside the states, however, it is an expense that I cannot afford. I am only 29 and am homebound. I am on disability, so I have a VERY fixed income. My husband, however, is in the process of settling a court case where he was hurt in a car accident by a drunk driver. We are hoping that we will be able to use part of the settlement money to go outside the U.S. for more treatment. I have done a little bit of research but because it is only a pipe-dream right now, I have not gotten too invested in it. I really do not want to be let down again. It is getting harder and harder every time something does not work.

[laid up doc]

why do they think you have such swelling/inflammation/nerve damage AFTER ADR??

are the nerves affected in the neural foraminae, or somewhere more distal?