New Member, old problems please help (Trying to get insurance to authorize a cervical disc replacement)

[ahennefer]

Hello all. I'm excited to be here as i can tell there are a lot of people with a lot of knowledge that could help. I'm 30 yr old male and have a been dealing with upper back and neck pain for over 7 years. I couldn't get a doctor to do anything for years and eventually stopped going until it got to the point that i couldn't golf and even once relapse due to a cough.

After finally getting an MRI on my neck late last year we've discovered a herniated disc. i think between C5 & C6. It's hernitated to the rear and pressing on my spinal column. I thought for a long time i may have a shoulder issue and discovered that i do have a weak rotator cuff issue and shoulder blade stabilizers. This i learned via PT. I thought for a while that i had scapula brusitis as a lot of the pain is in the left trap. It nots up like a rock when i relapse.

I'm told the issue is from the disc herniation and i hope they are right. Sports being my life have left me very depressed. At this point i'm too scared to do anything. I relapsed recently via basketball and am ready to get this thing fixed but my insurance is not approving the ADR, pro disc c. Further more, dealing with them, and the doctors and the people that are supposed to be helping me is worse. I'm on my own looking for the nessassary Peer reviews and medical journals to submit my final appeal to the NY department of health.

if you have advice on any of the above please help. Thanks.
my insurance is blue cross blue sheild

[Justin]

ahennefer,

Welcome. What insurance company do you have? Cervical artificial disc replacement has been much easier in terms of reimbursement / coverage for Spine Patients.

A few questions: what are your pain levels like? How is your quality of life, etc.? Surgery is a permanent bridge once you cross it.

I hope we can help support you.

[ahennefer]

justin,

pain can be and regularly is extreme. Recently i awoke after a golf outing to the most pain i've ever felt. Stars, tunnel vision and my ears where ringing for over 30 minutes. This is when i finally got a doctor to give me an mri after all these years.

i'm 100% ready for surgery and want to get it over with already and move on. I've been plagued with this for too long and it's progressively getting worse and more frequent. I'm at the point where almost any physical activity will put me out for weeks.

My insurance is blue cross blue sheild. I really want the disc replacement but at this point i'm so frustrated and bothered with the waiting, and appeal process that i'm considering just getting it fused. it's been ridiculous. I started the approval in december and am still waiting.

At this point im gathering peer review study's to support the final appeal to teh department of insurance in NY. I need the best ones and need to draft a letter. Any advice you have to help me would be great but, i'm going forward with one of these surgery's no matter what. I wouldn't wish my condition on my worst enemy. Really.

[Justin]

At this point im gathering peer review study's to support the final appeal to teh department of insurance in NY. I need the best ones and need to draft a letter. Any advice you have to help me would be great but, i'm going forward with one of these surgery's no matter what. I wouldn't wish my condition on my worst enemy. Really.

There are many peer-reviewed studies in the Educational Forum that you might find helpful (make sure to specifically do a search in that Forum to help find what you are looking for). I definitely agree with you regarding spine problems.

[ahennefer]

Thanks Justin. will look there.

[scduggan]

Dear Ahennefer,
Welcome to the website. I am so sorry about all your spine issues. I have to admit this is the third time I have sat down at my computer to type a reply to your post. I keep backing out because the bottom line is....I got nothin'. I just wanted to let you know we are thinking about you and wishing you luck. I know all about the insurance nightmare. I have UnitedHealthcare. Their reputation is just as bad as BC/BS for ADR. Good luck with your appeal battles. DO not give up HOPE and hang in there.
CD

[Katie]

Hi there,

Welcome to the forum, and like the others said, I'm sorry about your situation.

I have just come back from three level spine surgery, and one of those levels was the C5/6. I had an ADR put in, and so far, so great. It is made by Nuvasive here in the US, but for now is only available through Dr. Luiz Pimenta, whose home surgery is in Sao Paulo, Brazil. I'm in Canada, so it was quite the trip, but I would do it all over again tomorrow.

I had little pain from that disc, as most was from my lumbar. Or perhaps the amount of morphine I was on hid the pain in that level. However, I did have significant problems from the compression of the spinal cord at that level. I could not walk properly, and had issues with both bladder and bowels. I won't bore you with all the details.

The best thing I could do was send my MRIs and XRays out to numerous surgeons to get opinions. I'm from Canada and could not get the universal medical plan to cover my surgery so cost was also an issue. Dr. Pimenta was also able to provide me with non-metal appliances as I discovered that I was allergic to all others.

I was extremely impressed with his knowledge, care of the patient and skill, and would go back tomorrow if necessary. He uses a minimally invasive technique, and when my incision heals no one will guess that I had surgery on my neck. The cost was half of going to Germany, and one tenth of going to the US (I had consults with doctors from all of those places)

I hope you are able to find some relief soon. It took me over four years to finally get relief, but finally finding this surgeon was worth the wait. All the best to you.