The Insurance Warrior, Laurie Todd

[Justin]

Fighting with your insurance company about Artificial Disc Replacement (ADR) surgery coverage? Working on an appeal or planning your next step after being denied coverage?

Good news! The Insurance Warrior, Laurie Todd, has been advocating on behalf of the patient community. She's taken on and successfully appealed the insurance companies that have been denying coverage for patients.

Even though ADR surgery has been FDA approved since 2004, patients are still being denied coverage almost 5 years later.

Her book is a great resource and I wanted to pass it along to the Spine Patient Society:

Fight Your Health Insurer and Win: Secrets of the Insurance Warrior <-- Clickable Link





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LAURIE'S NEW BOOK IS HERE!

Hot off the presses!

It's a CD!

"The Sample Appeal: More Insurance Warrior Wisdom"

Check it out:

www.theinsurancewarrior.com/thebookandthecd.html

[Terry Newton]

Laurie Todd is the Insurance Companies nightmare in teaching clients how to successfully take them on and fight them on the same level they utilize to deny you the coverage that you have paid good money for. Laurie Todd is the guru in teaching clients the successful way of beating insurance company's at their own game. This book is highly recommended and useful in becoming an informed consumer, an assertive champion for your own cause, a tireless fighter in sticking up for what you have paid your good money for and why you have insurance to begin with.

Terry Newton

[runagain]

Hi, to all of you out there.

I am facing a fight with Blue Cross again for surgery.
If anyone has precedence of approvals to help me, please contact me ASAP.
I am not even sure if I will be able to get ADR surgery.
I will not have surgery at all if I cannot get approval through the hospital or the insurance.
I am in increasing pain but I don't think fusion, even though my doctor has a high success rate with it, will be good for me at all.
I have SI Joint issues and I consider fusion too risky with my history.
Surgery date is July 7.
I am praying that I can have this surgery.

Runagain

[Katie]

Runagain, it sounds like you need to get a second and third opinion on your situation. You have a surgery date, but don't know what surgery you are having? How long have you been battling the pain and the surgeon issues?

Take a deep breath and start prioritizing. It is easy to get overwhelmed and lost in the details. If you doctor is really good, why do you think the fusion will be too risky? You can always send your MRIs off to other surgeons for an opinion. I did that, sent mine to a different surgeon in NYC which gave me an entirely different outlook on things.

[runagain]

Katie,

I am having ADR but I was afraid I would be "forced" to have fusion because of the insurance situation.
I don't want fusion because of my SIJ issues like I said. It is taking a risk to have a surgery that is not the optimal one.
Fusion means more blood loss, longer recovery, adjacent disc degeneration issues, etc..
Been battling current issues for eight months.
I am happy with my surgeon and do not want a second opinion and don't feel i need one as this is my second operation with this surgeon, hence, the run around with Blue Cross again.
I am very frustrated with my insurance or UNinsurance as it should be called.

Runagain

[KBear]

Katie,

I am having ADR but I was afraid I would be "forced" to have fusion because of the insurance situation.
I don't want fusion because of my SIJ issues like I said. It is taking a risk to have a surgery that is not the optimal one.
Fusion means more blood loss, longer recovery, adjacent disc degeneration issues, etc..
Been battling current issues for eight months.
I am happy with my surgeon and do not want a second opinion and don't feel i need one as this is my second operation with this surgeon, hence, the run around with Blue Cross again.
I am very frustrated with my insurance or UNinsurance as it should be called.

Runagain

Runagain, I completely understand... unfortunately. As you know, I was in the Active L clinical trial to get my ADR. My hubby and I went to my daughters school the other night for a program she was in. We ran into a guy my hubby knew, he was walking with a cane and in a back brace. We went over and talked to him and asked him what had happened. He explained he had a fusion on his back. We told him that I had just had surgery too. We chatted a little and I told him I was 8 weeks post op. Turns out, he was 3 months post op and still that limited. Here I was, no brace and wearing 3 inch heels and he was still in a hard brace,using a cane and was clearly having a hard time walking. When my hubby and I reached the car, I looked at him and said "now do you see why I was so i insistent on ADR?" I am so glad that I was able to have the ADR.

I don't want to discredit fusion either, as it is best for some people. It is still a valuable procedure and has helped many people get out of pain, as we know. My dr's and I just didn't feel it was best for me. That is the problem here, that the choice of which surgery to have, should be between a patient and a dr. Not up to some 'consulting dr' that is hired by the insurance to deny us. Insurance needs some major reform, as it should be criminal to deny us the surgery that is best for our body, whatever that surgery may be.

Kathy

[runagain]

Kathy,

You are right on. Fusion is right for some people and others like you or I, it is not. It does depend on the situation and the individual patient.
My doctor gave me the choice of an ALIF or ADR. That is the way it should be, decisions between a physician and the patient.
The insurance companies have too much power and they really need to be stopped. They are making so much money and at the expense of people who are just trying to get better. Some of their actions lead to the deaths of patients and i do not believe that they care.
They are the middleman in health care, driving up costs.
When I was first in PT, I would ask my PT how I was doing compared to fusion patients. The answer was like i was at 5-6/10 pain instead of 7-8/10 pain for a fusion patient, this being an example of pain levels.

Thank you for the support.

[Katie]

Has anyone gotten the price breakdown/difference between the ADR and fusion surgeries?

Here in Canada, it is almost identical, at least according to the Government report by the Medical Advisory Secretariat for the provincial insurance plan. And almost every study out there states that long term, ADR is much cheaper, as it is supposed to be more successful and prevents adjacent segment disease, just more surgery down the road to deal with that.

Why is none of this taken into consideration by the Insurance companies? And I'm including our government system here too. It makes absolutely no sense, but that doesn't seem to matter as far as insurance companies go, I guess.

It shouldn't be hard to get the figures for each basic surgery in the States, and use that for evidence, should it?

Also, how many here have used the Insurance Warrier mentioned here, either using her book or hiring her to help in their cases, and if so, has it worked? If she is that good, why are more patients not using her? I am off to get her book if my new application does not come back with a positive answer next week. I've skimmed the contents, and am really angry with myself that I didn't pick it up a lot sooner. I think it would have saved me a lot of stress.

[treefrog]

http://www.ncbi.nlm.nih.gov/sites/entrez
From: Spine J. 2007 Sep-Oct;7(5):558-62.

An economic model of one-level lumbar arthroplasty versus fusion
Guyer RD, Tromanhauser SG, Regan JJ

Abstract
Background Context: Degenerative disc disease (DDD) is a cause of low back pain commonly requiring surgical intervention. The option of lumbar total disc replacement (TDR) represents an advance in the surgical treatment of DDD. However, new treatments, particularly those that include the use of new implants, may lead to increased costs to both hospitals and payers. Therefore, it is both necessary and appropriate to examine the potential costs associated with a new procedure such as total disc replacement compared with traditional treatments for a specific pathology.
Purpose: To perform an economic analysis of lumbar TDR versus three different techniques for lumbar fusion.
Study Design/Setting: A cost-minimization model.
Methods: An economic model examining hospital and payer cost perspectives was developed to compare costs of TDR with the CHARITE Artificial Disc to three spinal fusion procedures: anterior lumbar interbody fusion (ALIF) with iliac crest bone graft (ICBG); ALIF with INFUSE Bone Graft and LT-Cages, and instrumented posterior lumbar interbody fusion (IPLIF) with ICBG. The hospital perspective compares direct medical costs during the index hospitalization. The payer perspective considers direct medical costs of the index hospitalization and those incurred in the following two-year period. The model contains a Diagnostic Related Group (DRG) arm based strictly on DRG coding and payment, and a per-diem arm that includes a device carve-out cost and payment.
Results: In the DRG and per-diem arms of the model, compared with TDR, hospital costs are 12.0% higher for ALIF with ICBG, 36.5% higher for ALIF with INFUSE, and 36.5% higher for IPLIF. For payers, in the per-diem arm compared with TDR, ALIF with ICBG has 4.4% lower cost, whereas ALIF with INFUSE and IPLIF have costs of 16.1% and 27.1% higher, respectively. In the DRG arm compared with TDR, payer cost is 87.1% higher for ALIF with ICBG, 82.8% higher for ALIF with INFUSE, and 99.0% higher for IPLIF.
Conclusions: The model shows that the overall economic effect of one-level TDR procedures on hospitals and payers is likely to be less than or at worse equivalent to one-level lumbar fusion procedures.

Keywords: lumbar spine; arthroplasty; disc replacement; fusion; arthrodesis; economic model; CHARITE(TM) ARTIFICIAL DISC; COST-EFFECTIVENESS ANALYSIS; TRAUMA PATIENTS; BONE-GRAFT; FOLLOW-UP; DEVICE; SPINE; REPLACEMENT; RADIOGRAPHY; MANAGEMENT

[treefrog]

Let me know if you want a PDF copy of this journal article. Send me a PM with your email address, and I can send it to you.