Blue Shield -- Artificial Disc Replacement Coverage

[mmarsh]

Where do you find negative info? It's difficult to find. Also, is it worth the risk to have an ADR, knowing that another fusion could end my active lifestyle? My surgeon has done lots of ADR and he prefers ProDisc. I know there are failures, but I'd really like my life back! How do I know which is a better gamble? It's all very confusing! I just wish the pain would spontaneously disappear (isn't that a nice fantasy!)! I just don't know what to do at this point. Is it worth the risk to get ADR or stay the course and get another fusion (which is almost guaranteed to cause yet more problems)? What to do, what to do!?

[KBear]

Where do you find negative info? It's difficult to find. Also, is it worth the risk to have an ADR, knowing that another fusion could end my active lifestyle? My surgeon has done lots of ADR and he prefers ProDisc. I know there are failures, but I'd really like my life back! How do I know which is a better gamble? It's all very confusing! I just wish the pain would spontaneously disappear (isn't that a nice fantasy!)! I just don't know what to do at this point. Is it worth the risk to get ADR or stay the course and get another fusion (which is almost guaranteed to cause yet more problems)? What to do, what to do!?

That's the million dollar question...... that we each must answer for ourselves.

[Katie]

mmarsh, I fought for years for the right to have at least one ADR in my lumbar. Every surgeon here in Canada told me that I wasn't a candidate for any surgery...they didn't operate" just for pain".

When I found a surgeon internationally, I ran into another roadblock...I was allergic to every metal appliance they could put in me. I was able to have a cervical non-metal ADR put in, but there is no such ADR for the lumbar. So despite my original misgivings, I went for fusion in my L4/5 & L5/S1. A plastic PEEK disc was used in those levels, with no additional hardware.

I am so happy to be almost pain free after five years of agony. Yes, I could have waited another two years at least to see if a suitable one became available, but I know I could not have lasted that long. This was what life threw at me, and I am glad to have a chance at being 'normal' again. With luck, I'll be one of the fortunate ones that doesn't have problems down the road, but I figure that could happen anyway, because of advancing age.

We all have to make big choices...I hope we are providing you with enough information to help make an educated decision.

[mmarsh]

KBear and Katie

Thanks for your responses. I have been working with the same surgeon for many years and have always trusted his professional opinion. I think my best "gamble" is to continue to do so. I realize any surgery is a risk, but I want at least some semblance of my life back! What I need now, I think is to find out how to get BS to pay for at least some of the surgery. They don't cover ADR, but are they on the hook for any of the cost of the surgery? What happens if there are complications? I know I can't prepare for every eventuality, but where do I start?

M-

[KBear]

Check in the insurance section as I started a thread about whether insurers paid for surgery, if they denied it and then paid or paid partially after denying it, etc. My insurer denied me twice, was not paying and so on. I went in the clinical trial, which did pay for surgery, but they also filed on my insurance to see if any of it would be covered. I don't remember the exact amount my insurance paid and it wasn't a huge amount, thinking @ 10k, but they did pay some of it. I have an individual policy (my hubby is self employed and I'm a homemaker) and they are notoriously awful. I was pretty shocked to see any payment whatsoever. If your insurance is through an employer, they have some say in whether your surgery is paid for or not. I know I've heard of people going to the HR department and 'petitioning' them to pay and some get it paid for.