C4 to C7 Disc Herniations Denied by BC of California for ProDisc Cervical Artificial Disc Replacement

[bazel01]

Hello, I am 34 and have had neck pain caused from herniations in my c4-c7 for the last 6 years. the pain has been much worse for the past year and have been told fusion was not the best option but that i would be a good candidate for pro disc c replacement. Unfortunately my insurance (blue shield - california) have refused to cover the procedure. They claim the surgery is investigational. Has anyone convinced there insurance companies to cover this procedure, and if so how?

[DanielleP924]

Hello, I am 34 and have had neck pain caused from herniations in my c4-c7 for the last 6 years. the pain has been much worse for the past year and have been told fusion was not the best option but that i would be a good candidate for pro disc c replacement. Unfortunately my insurance (blue shield - california) have refused to cover the procedure. They claim the surgery is investigational. Has anyone convinced there insurance companies to cover this procedure, and if so how?

Welcome to the site Bazel01. I just joined a couple of months ago myself. It's been a wonderful place to talk about all my spinal issues and other things that go along with it.

Good luck getting your insurance to get with the program.

DanielleP924

[Justin]

Hello, I am 34 and have had neck pain caused from herniations in my c4-c7 for the last 6 years. the pain has been much worse for the past year and have been told fusion was not the best option but that i would be a good candidate for pro disc c replacement. Unfortunately my insurance (blue shield - california) have refused to cover the procedure. They claim the surgery is investigational. Has anyone convinced there insurance companies to cover this procedure, and if so how?

Hello Bazel. I'm sorry you are dealing with spine issues, especially at your age (I know how it is ). Unfortunately, Blue Cross / Blue Shield have changed their story over the last couple of years in an ongoing effort to deny Spine Patients artificial disc replacement surgery. There are Members on the Forum that have been successful in having their insurance companies cover their surgeries. A handful of cases have even been covered for artificial disc replacement overseas (mainly Stenum on this Forum). Make sure to take a look in the Health Insurance Forum here at the Spine Patient Society for more information. You can also use the "Search" feature in the upper right-hand corner of the Forum to help locate pertinent topics.

I hope this helps.

[New-disc]

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[KBear]

to the forum. Wish I had some great news or secret on how to get insurance companies to pay; but unfortunately, their paying for ADR is few and far between. I appealed mine twice, had a letter from my surgeon, who also had several articles published in medical journals, 2 of them included that he wrote regarding ADR and still was told it was investigational. I was also denied based on my age, 28 at the time, being told I was so young and there was no long term data on how long an ADR will last.

I ended up being in a clinical trial here in the US and got the Active L disc, which is approved overseas already and has been used there for a few years. It was also in it's final stage of trials here, so I felt it was safe.

That is definitely something worth checking into and seeing if you can find a disc you like in trials and a top notch surgeon doing the trial (most surgeons in the trials are top docs).

Good Luck and let us know if there is anything we can help you with.

[wendyayers]

Hi, I just had C3/4 4/5 and 5/6 cervical disc replacement with Dr. Bertagnoli from Germany almost 5 weeks ago. I have Blue Cross/Blue Shield and I sent letters and talked w/ a rep for 3 months. I was denied-and paid out of pocket. I was told not to fuse over and over again. Good Luck

Wendy

[JK2234]

I just turned 30 and have severe DDD with Herniations and stenosis at 3 levels C3/4-C4/5-C5/6 and im also just trying to stay alive day by day until I find help...

[wendyayers]

That is the exact same diagnosis that I have (hopefully had). I'm 42 and was diagnosed last April. I have had 88 treatments (steriod injections, accupunture, chiropractic, physical therapy, ect.)

I am now almost 5 weeks post op. I had a 3 level C3-C7 disc replacement with the Pro Disc N from Dr. Bertagnoli in Germany. Today I took nothing but advil!

I know what it is like to be hopeless, be depressed, and wonder if your life with ever be the same. I'm hoping that 2010 will bring health and happiness-if you have any questions, pls. ask

Wendy

[JK2234]

^ Wendy did you have pain in your arms or just your neck?

Would you say you feel much better at 5 weeks post up then you did before surgery?

[wendyayers]

Hi, I had pain in my right arm. I couldn't hold a fork, lift a glass, I had no strength. This all happened overnight. I had an EMG test, I had nerve damage from C5-C6, that affected my deltoids, biceps, ect. Numbness move down to my wrist.

I know it's really scary. 5 weeks post op-I'm hopeful, my arms are still weak, but the numbness come on more as the day goes on. My legs felt heavy-the heaviness is not their in the morning, comes back as the day goes on also.

I don't have the pain in my neck anymore, just more shoulders where they had to move all of the muscles. I did try EVERYTHING to avoid surgery. I had 3 epidurals, prednisone, ect.ect.

I went from one day getting ready for the regional championship in tennis (adult "for fun" league)-I played 4 hours a day. The next day I woke up with a horrible stiff neck-that last a week, then I couldn't move my head back or to the side, and I couldn't lift my right arm. Scared, depressed..

Every surgeon told me first to avoid surgery, wait 6 months, give it time to heal on its' own, and avoid a 3 level fusion.

It took me out of my life, I isolated myself. NOW-I am hopeful. I better get better. I know I can't push myself and it takes time so I just have to take each day as it comes. But, If I didn't have the surgery, I know I would never get better. Now, I have a chance, and it's worked on alot of people.

How did you injure yourself?