ANYONE know of United Healthcare approving ADR?

[scduggan]

Hello Everyone,
I love this website. You are all very knowledgable and supportive. I will briefly describe my situation as it is nothing new to any of you. I am a 44 year old female. I have DDD at L4/L5. I feel like I have been dealing with this daily pain for years, but if I really look back I would have to say it has been about 2 and a half to three years of life-altering problems. It seems a lot worse in the last several months, and I can only guess it is just the progression of the disease. First let me say I have always been healthy and active. In the past I just had plain old low back pain. I always described it as feeling like someone hit me in the low back with a bat. Now, I have a lot of weird things along with the back pain, mainly spasms, weakness in both legs and sometimes weird numb section of my hips. I am functioning and hanging in there. I have three sons aged 11, 9 and 7 and a husband who travels quite a bit. I have lortab and robaxin, which I take usually a couple of times a day. I have three opinions and a wonderful OS, all in agreement that I am a good ADR candidate.

I need some help. First, does ANYONE know of United Healthcare approving ADR? I think they do, although I just received a denial letter from them (this was from the initial prior-auth from my doc). I am not surprised by the denial letter. I am now working on a really great appeal letter. Should I get my OS to review my letter before I send it? This is a first level appeal. My doc will send a letter and I will send mine at the same time.

Last but not least, (I think this is normal) would you explain your mental state as being kind of all over the map? I am truly hanging in there...I have to. Sometimes I feel like I can't take another minute. The restrictions caused by my back pain make me feel like a slug. I would do my surgery tomorrow. Hopefully it will not be too long. Thanks to all!
CD

[linda]

Hi CD,
Welcome to the site. I'm sorry you are having so much trouble. I'm having a lot of the same problems as you, especially the bat in the back!
I also have United and as far as I know they do not cover ADR according to my doctor. I haven't tried to contact them. I am getting reenrolled in a clinical trial next Tues. for the Axiomed/Prodisc. It is for one level only but I've heard Justin and Katie say that some places do sympathy cases or something like that. Do you need both L4 and L5? If I decide to do this surgery I will have a 50/50 chance of getting the Freedom Disc or the Prodisc. I will also have to pay my max out of pocket from United which is $5,000 which I really don't have. They will follow my progress for several years and I will have to get a lot of X-rays. Wishing you much success in your surgical journey.
Linda

[rhatzy]

CD,

I had United health although they were just the administrator of the health plan for my company which was self insured. They won't pay for any Lumbar ADR, but I heard that they have paid for a cervical ADR.

I went to Germany for a two level Lumbar ADR and it now coming up to two years with them and I am doing great. However, I had the pain, the depression, the drugs and all of that and it was tough. It cost me $40,000 for my ADR's, but it was worth every penny.

Mark

[Katie]

CD, everything you are going through is normal. And yes I know that helps a bit Many of us have gone through several cycles of hope, despair, anger and numbness. It sounds a lot like the different levels of grief.

I think the worst moment ever for me was when I got the letter of denial from my insurance, saying that I couldn't go to Germany for three level ADR. I raged, screamed, cried....all in front of our priest. I had put in months of full time effort with that application, with countless documents and studies saying that this was the best thing for me.

And the moment I was the most calm was when I got the report from the University lab a few weeks ago, saying that I was extremely reactive to almost every metal that was in every ADR out there. I'm now looking for something, anything that is made of titanium, ceramic or polyethylene, the only things to which I am not allergic. I should be in the depths of despair, but it's just not there. I am used to the pain now and can manage it with narcotics. It's not ideal, but it's better than being on the roller coaster of emotions like the past four years. That was starting to affect our marriage worse than the pain was ruining me. The emotional pain was winning and I couldn't let it.

Like you, I've been healthy and active until this hit. I think the best thing you could do is find a pain management doctor with whom you can work, build a support group around you to help with the bad days (or weeks) and hang on to that doctor with your life He sounds like a keeper, and one of the hardest things to come by is a doctor who will support your goal of surgery you both agree to. I really hope that you resolve your problems quickly, but if it drags on, realize that there are resources out there that can help (including us )

May I suggest having a look at the Insurance Warrior? It's a book/CD that has a lot of great ideas for an appeal. You'll find a link to it here if you do a search. If my appeal is ever revived, this will be a big part of it.

I'm so glad that you decided to post here and join the party

[ajj1001]

Hi CD, welcome and sorry you have to be here.

alison x

[Cindylou]

Welcome CD. Some very good advice you have been given. And the range of emotions that you describe are all very normal, as Katie suggested. The Insurance Warrior is a terrific resource so be sure to do a search on that and her, Laurie. Hang in there, and let us know how we can help you along the road.

[Justin]

Hello Everyone,
I love this website. You are all very knowledgable and supportive.

Hi CD. Welcome to the Spine Patient Society! Thank you for your kind words and feel free to make yourself at home.

I will briefly describe my situation as it is nothing new to any of you. I am a 44 year old female. I have DDD at L4/L5. I feel like I have been dealing with this daily pain for years, but if I really look back I would have to say it has been about 2 and a half to three years of life-altering problems. It seems a lot worse in the last several months, and I can only guess it is just the progression of the disease. First let me say I have always been healthy and active. In the past I just had plain old low back pain. I always described it as feeling like someone hit me in the low back with a bat. Now, I have a lot of weird things along with the back pain, mainly spasms, weakness in both legs and sometimes weird numb section of my hips. I am functioning and hanging in there. I have three sons aged 11, 9 and 7 and a husband who travels quite a bit. I have lortab and robaxin, which I take usually a couple of times a day. I have three opinions and a wonderful OS, all in agreement that I am a good ADR candidate.

Spine issues can truly turn one's life upside-down. Most of us here have experienced life-altering spine issues and we are here to support you in any way we can.

I need some help. First, does ANYONE know of United Healthcare approving ADR? I think they do, although I just received a denial letter from them (this was from the initial prior-auth from my doc). I am not surprised by the denial letter. I am now working on a really great appeal letter. Should I get my OS to review my letter before I send it? This is a first level appeal. My doc will send a letter and I will send mine at the same time.

Like others have stated, UH does not cover artificial disc replacement. My Dad has UH and I called them directly (I also checked their policy on their website) and they do not cover artificial disc replacement. Here's a link on United Healthcare's website Artificial Total Disc Replacement for the Spine.

Last but not least, (I think this is normal) would you explain your mental state as being kind of all over the map? I am truly hanging in there...I have to. Sometimes I feel like I can't take another minute. The restrictions caused by my back pain make me feel like a slug. I would do my surgery tomorrow. Hopefully it will not be too long. Thanks to all!
CD

Spine issues not only affect one's body, but also one's mind. Depression is common in patients with chronic conditions. Many of the medications that Spine Patients take for control of their pain are centrally acting and are very cognitively dulling. However, there are various medications that can help treat depression and help stabilize one's mood while dealing with spine issues and chronic pain (please discuss all changes in medication with your treating physician[s]).

If you need anything at all, please don't hesitate to send me a private message, email, or by contacting me using the person-to-person chat feature.

[Greg]

Welcome to the site CD. Sorry you are having to go through this. I have BC/BS and havent ever heard of them covering 2 disc ADR but my (potential) surgeon sent off the pre-auth and I am waiting for the denial letter to come back so I can start my appeal process. Unless I find a trial out there that will do 2 disc ADR. Good luck with your appeal and like Katie said, the insurance warrior is some great information concerning appeals.

[Keano16]

I have three opinions and a wonderful OS, all in agreement that I am a good ADR candidate.

I need some help. First, does ANYONE know of United Healthcare approving ADR? I think they do, although I just received a denial letter from them (this was from the initial prior-auth from my doc). I am not surprised by the denial letter. I am now working on a really great appeal letter. Should I get my OS to review my letter before I send it? This is a first level appeal. My doc will send a letter and I will send mine at the same time.
CD

Hi CD, welcome...

I just wonder, why immediately go to most invasive option (ADR)?

Its pretty obvious you suffer from discogenic low back pain. There are several types of treatments (surgeries) that can control or even eliminate your pain. Why don't you try some of them before ADR?

[scduggan]

Dear Keano16,
Thanks for your reply. I have already tried all the conservative treatments. I am starting to have some nerve impairment. My OS gave me three options: fusion, IDET or ADR. He will not do a fusion on me because the degenerated disc is at L4/L5 and I am relatively young. The IDET is just a bandaid because my disc is pretty much shot. It had leaked all the fluorescent fluid in the two minutes it took to wheel me from the discogram procedure room to the CT scan. I know ADR is extreme. I have spent hours and hours researching. My OS is wonderful. He is one of the trial docs from the Charite' trials. He is VERY conservative as he has had four back surgeries. My disc will not heal. I am still functioning because I have three sons and a husband who travels a lot for work. I am terrified of not being able to care for them. My insurance will pay for a fusion. I just have to trust my OS on this one. I think I would consider it for DDD at L5/S1. Thanks for your post. I am so glad to have people who know about spine issues, and I love people who ask tough questions. This is something I have been praying about for months.
CD