NBCBS Federal plan. Does anyone in this forum have experience with getting an ADR approved?

[melduforx]

Hi,

Glad to have found these forums as there seems to be a lot of good info in here.

Back in February I experienced SEVERE pain down the entire length of my right arm including uncontrollable muscle spasms. I received a course of steroids and some of the pain went away, buy my physician referred me to an orthopedist.

An MRI found a bulging disc at C2-3, a herniated disc at c5-6, and a severely herniated disc at c6-7 that is pressing on my right nerve root.

Since February the pain has increased significantly and is now in both my right and left arms. I'm on 900 mg of Neurontin a day and it isn't helping as much as it used to. The side effects of dry mouth and eyes aren't very fun either.

I'm 30 years old and fairly active, and there was no accident or injury that led to the herniations.

My first surgeon recommended fusion of C5-6 and C6-7. Since I'm relatively young, I'm worried about future herniations and the impact of fusion.

I went to see a doctor up at George Washington University who does disc replacements and he is recommending ADR using the prestige at C6-7 and a fusion of C5-6.

With the Prestige I know I won't be able to get an ADR directly above or below, so that concerns me, but my doctor has told me that he prefers the use of the Prestige because of its reversibility and the lack of bone ingrowth on the device.

I have the BCBS Federal plan. Does anyone in this forum have experience with getting an ADR approved?

Also, does anyone have any recommendations of surgeons in the Virginia or DC area? The two surgeons I'm seeing right now are great, but it never hurts to have another opinion.

I'd appreciate any advice that any of you has to offer. I'm feeling overwhelmed right now and most of the information that's out on the web seems to be the same stuff posted over and over.

Thanks in advance.

--Joe

[ajj1001]

Hi and Joe

I'm 30 years old and fairly active, and there was no accident or injury that led to the herniations.

I was early 30's when my discs "went" and similarly had no reason why. It was very overwhelming never having been ill with anything at all before. Hope you find some answers here.

alison x

[Gilbert P]

Joe

to the spine world you have found a very helpful group of loving caring people.

All The Best

Gil

[New-disc]

Welcome!!!

[Katie]

Hi Joe. I wish I could help more with the information, but I'm in Canada. I have seen one of the top surgeons in the eastern US though (in NYC) and would highly recommend him.

Unfortunately from what I've learned here, it is very difficult to get any of the insurance down there to pay for ADR, but a few here have been successful, with a lot of determination

We all understand your sense of being overwhelmed, and if nothing else, can support you though it. Speaking from past experience, it does go away as you work your way through the system, and just rears itself occasionally when you hit a speedbump.

, pull up a chair (if you can sit much) and make yourself at home here

[Justin]

Hi Joe,

Welcome to the Spine Patient Society! I'm sorry you need to be here, but there are people (like myself) that have been in your shoes before.

I have the BCBS Federal plan. Does anyone in this forum have experience with getting an ADR approved?

Also, does anyone have any recommendations of surgeons in the Virginia or DC area? The two surgeons I'm seeing right now are great, but it never hurts to have another opinion.

Joe, the good news is that the BCBS Federal plans have a good track record of covering artificial disc replacement procedures. In terms of another surgeon, I would suggest Paul C. McAfee, M.D. He's at the Towson Orthopaedic Associates: Scoliosis & Spine Center of Maryland. I'm not sure how much of a trek that is for you, but I've talked to patients that are very pleased with Dr. McAfee.

If you need anything, please don't hesitate to contact me via private message, email, person-to-person chat, etc. We are here to help in any way we can.

[rhatzy]

My insurance is now paying for single level cervical ADR. The prodisc can be used at multiple levels as can the M6.

Mark

[roomba]

Welcome Joe! Sorry you're in so much pain.

I had cervical disc removal and fusion 11 years ago. My problem came from nowhere too - the doc said it was an old injury and the disc finally gave out.
The nerve pain down the arm was horrible; I have been completely pain free since the surgery.

I hope you find the right surgeon and whatever procedure you choose gets rid of your pain.

[Terry Newton]

Joe:

I have two Prestige Discs approved by Blue Cross of Michigan and the surgery was done at Stenum Hospital in Germany. The costs were about $64,000 and I was reimbursed at 100% of my monies paid.

I am not sure why they are not recommending two discs for you other than only one is approved in this country. I would check in to having the both of them done at Stenum.

I was not interested in a fusion in any way, shape, or form. I am three years out of surgery on November 4th and consider my surgery to be successful.

If you would like any further help please PM me.

[Patti]

Welcome Joe....we are neighbors. I'm in Alexandria, VA and starting all over again with my ailing spine. My issues are lumbar. I had surgery in April, 2008, at Fair Oaks and am still in alot of pain. I have an appointment with a Georgetown neurosurgeon on Monday. Dr. Faheem Sandhu and Wm. Lauerman in December, also at Georgetown. I'm told that Dr. Donald Hope is great with necks as well as Anthony Caputy at GW. Caputy operated on Cheney and Laura Bush, so I assume he made it through the vetting process.

I also consulted with a couple of guys at Hopkins who recommended the two guys listed above. Best of luck and maybe we can talk off-line if you'd like.