Determined to feel better! (Need 2 level ADR...Insurance nightmare has begun)

[texas315]

Hi, all! I'm new here and have done a lot of reading on this site and feel very encouraged and comforted knowing that there are other people out there going through the same thing I am. I realize now that my little world is not so small.

I need a 2 level disc replacement (refuse fusion) and I WILL somehow, someway get it. I have begun the fight with BCBS and I am also exploring all of the other options. Thankfully I have a wonderful and loving family that will support me in anything I need to do in order to feel better. I wish us all to be pain free!!!

[ajj1001]

Welcome to the forum and I hope you find a way forward soon.

alison x

[Gilbert P]

We feel your fustration and pain we are all in the same boat at times sinking but some how we manage to stay afloat

This site is full of support and suggestions

I am also fighting with Insurance Laurie Todd has some great information check it out in forms.

Two level ADR may be hard to find here in the states FDA is only permetting one level. Some Dr are doing two. Dr Bitian, Dr Yue, Dr Delemarter, Dr, Zegler etc You could also check out Dr overseas?

We are here to help

Wish You The Best

Gil

[Keano16]

Welcome to the boards.

So, one more IDET "failure". You did not posted your diagnosis, I suppose its DDD at 2 levels. You've already tried to fix one level with IDET, which obviously did not help. There are more options for you before ADR, you should explore all the possibilities like biacuplasty and selective endoscopic discectomy.

Then if this disc is better, you can do one level ADR. Just a suggestion.

With DDD, and discogenic low-back pain ESI does not help. Thing that can help you is ganglion infiltration (L1 and L2).

Regards

[KBear]

Welcome to the boards and you are definitely in the right place. I also had an IDET that failed, actually made me worse. I had ADR at 1 level over a year ago. I fought insurance for 6 months and then decided to be in a clinical trial. I am so glad I had surgery and feel so much better. It is worth all the pain and suffering to be able to be me again. Does your doctor feel that a 2 level ADR is the best choice for you? If so, then fight for what your body needs, not what your insurance wants to pay for. Best wishes, Kathy

[kwmillie]

Hello and Welcome to the boards. I hope that you can get what you need here in the States, but according to what I know, no insurance company is approving 2 level ADR's here, so going overseas will be your best bet. This place has a lot of good information on overseas Doctor's, so check it out. Take care and I hope that you can get some answers soon.

Millie

[Greg]

Hi, all! I'm new here and have done a lot of reading on this site and feel very encouraged and comforted knowing that there are other people out there going through the same thing I am. I realize now that my little world is not so small.

I need a 2 level disc replacement (refuse fusion) and I WILL somehow, someway get it. I have begun the fight with BCBS and I am also exploring all of the other options. Thankfully I have a wonderful and loving family that will support me in anything I need to do in order to feel better. I wish us all to be pain free!!!

....what state is your BCBS in? I tried fighting them for a while on my 2 level ADR on the same levels but I couldnt take the pain anymore and settled with fusion....and I used to be like you and said HELL NO to fusion but I have educated myself enough to see beyond the scary tales of fusion and realize that it will work for me. Given the location L4-S1, fusion would not be as bad as the worst case scenarios that probably concern you. And you can win with the insurance if you just stick in there and fight for your life. There are many people insured by BCBS who have had their ADR's paid for so make sure to research and find their EOB's, court cases or trials and everybit of documents you can proving to BCBS that ADR is the right and only option for you and would save them a lot of money. Check the other posts for Laurie Todd (The Insurance Warrior) in the Insurance Section; you will learn so much from the free advice and I highly recommend buying her book if you plan to fight them until they pay. The 20-40 bucks it cost is worth getting your life back. You only get a few chances when it comes to appeals and nobody has more of an interest in your life than you so you need to become an insurance appeal expert and not rely on your doctor to do the appeal for you. That appeal should be a book

Another option that might not be bad....IF ALL ELSE FAIL AND YOU HAVE TO GO TO SURGERY....is doing a hybrid surgery. They fuse L5/S1 which naturally barely moves at all so fusing it is like nothing ever happened and do an ADR for L4/L5. But you still need to get around the ADR part with the insurance (and why they'd rather pay 100k for fusion vs. 35k for ADR i do not understand....I guess they dont like being proven wrong) My doctor suggested to me to do 2 level fusion and bill insurance for it. I would have to buy the artificial disc myself and they would "slip" it in at L4/L5 during the surgery. According to the insurance company their doing a fusion so they'll pay for everything. But the disc could cost from 4-8 thousand dollars.

I used to be rock solid on only ADR and NOOOO FUSION! Through my research I have learned that the hybrid would have been the best but I couldnt afford the disc or wait long enough to win the appeal. I wish you the best of luck on whatever route you take but I do hope that before you rule out fusion all together you make sure that your opinion on it isnt biased and is a well educated one. Now of course doing fusion or ADR should be the ABSOLUTE LAST RESORT after everything else has failed. I took 2 years and thousands and thousands of dollars to rule out every possible option before I settled on fusion. But I am comfortable with that decision because I know it is the absolute right one. We've all had to deal with this pain for way too long of a time but whats just a little bit longer to wait before we make an unreversable decision about our spine.

Sorry to blab on forever but I hope I have at least said something that can help guide you in your path to a pain free life

And if you are going the major surgery route, please look into the hybrid as L5/S1 really doesnt move much so putting a device in their to preserve motion when you dont need to doesnt make sense to me. Plus at least one of the disc doesnt have the chance of the hardware malfunctioning/breaking/wearing down/falling out of place.........GOOD LUCK AND DONT HESITATE TO ASK IF YOU NEED ANYTHING....WELCOME

[KBear]

Completely agree with Greg, great advice.