6 Weeks Until Surgery (Cervical Spine)

[tucsonmikenc]

I am 6 weeks from surgery new MRI and cat scan will determine if hyrbred of fusion at C6-7 and ADR at C4-5 and C5-6 are still possible. HR dept. has said UHC will deny coverage, and will have to appeal even though submission hasn't been submitted yet by surgeon. looking for help in 2 areas has anyone written an appeal after a UHC denial and succeeded, and does anyone have a current list of companies that are paying for ADR. HELP!!!!

[trkdoc714]

Mike,

This is a link I stumbled on a few weeks ago from a spine clinic in Colorado. It appears they keep it up to date so it may list your insurance company.

http://www.rmsas.com/documents/Payor...yCasebasis.pdf

I hope this helps,

Bob

[KBear]

There is a member on here, Researcher, who is gathering the same information. You may want to message him. Good luck

[tucsonmikenc]

Thanks for the help.. Info is exactly what I needed. I really appreciate the help.

[Researcher]

tusconmikenc,

The link provided above is for insurers providing coverage on a case by case basis. You can see companies that have a published policy of covering cervical ADR (100%, not case by case) at http://www.rmsas.com/documents/PayorswithpositivecoveragepoliciesforADRasofAugust PositiveCoverageCervical.pdf.

Please understand that just because a company pre-approves your ADR surgery, it does not mean that they will pay what you expect them to pay when the surgery is done. Laurie Todd's latest newsletter talks about this (see health insurance help). I will post a copy of the newsletter as soon as I can get her permission.

Phil

[Justin]

I am 6 weeks from surgery new MRI and cat scan will determine if hyrbred of fusion at C6-7 and ADR at C4-5 and C5-6 are still possible. HR dept. has said UHC will deny coverage, and will have to appeal even though submission hasn't been submitted yet by surgeon. looking for help in 2 areas has anyone written an appeal after a UHC denial and succeeded, and does anyone have a current list of companies that are paying for ADR. HELP!!!!

Hi Mike,

I believe we have spoken in the past. Unfortunately, United Healthcare is one of the insurance companies that does not cover artificial disc replacement (ADR) surgery. Researcher has provided you with a great link about insurance companies that are covering ADR.

I do hope you are making steady progress in your recovery. Please keep us posted on how you are doing.

[tucsonmikenc]

Sorry, that should more appropriately have read 6 weeks until surgery. Dec. 8th is my date. UHC is one of the plan administrators our company funded plan utilizes, as is BCBS Anthem of Missouri. We choose each year based on which administrator covers more provides where our office location is located. Our home office is in St. Louis, Missouri where I am having the surgery at Barnes. So the final decision is up to our company committee. Since BARNES is located where our home office is I am hoping to get more support in my final appeals essentially locally. I am in North Carolina and am flying there for my surgery. I will stay some extra days before flying home after I am released from the hospital. I did see on one list where BCBS did approve one ADR that is known of so that along with many other things is what I will use in my appeals.

[Justin]

Hey Mike,

I was just checking in to see how your operation went. I hope you are doing well.

[tucsonmikenc]

Things did not work out as I thought they would. The space between my cervical vertebrae had decreased to significantly less than 5mm, in addition they had become too deformed to support having disc replacement. Danger from retracting them far enough apart to insert artificial discs was far too great. All this after having finally gotten the ADR approved. Such is life. Doctor says at this point auto fusion is progressing quickly enough that in the years ahead that would be the best thing to allow to happen. Fear not this was from one of the top doctors in the country if not the world. He does cervical spine surgery on NFL players and other athletes and neurosurgeons. He donates all proceeds from any device he participated in clinical trials on to charity. So I am confident in his recommendation. I think everyone needs to know that sometimes the window of opportunity closes and ADR may not be possible. Thanks for asking. Best of luck with your future..

[KBear]

Things did not work out as I thought they would. The space between my cervical vertebrae had decreased to significantly less than 5mm, in addition they had become too deformed to support having disc replacement. Danger from retracting them far enough apart to insert artificial discs was far too great. All this after having finally gotten the ADR approved. Such is life. Doctor says at this point auto fusion is progressing quickly enough that in the years ahead that would be the best thing to allow to happen. Fear not this was from one of the top doctors in the country if not the world. He does cervical spine surgery on NFL players and other athletes and neurosurgeons. He donates all proceeds from any device he participated in clinical trials on to charity. So I am confident in his recommendation. I think everyone needs to know that sometimes the window of opportunity closes and ADR may not be possible. Thanks for asking. Best of luck with your future..

I'm so glad you had a doctor that was more concerned with your well being than what was being done. I know mine told me that if he got in and I needed fusion, that I would wake up with fusion and not ADR. This was comforting to me to know that they would do what was right, not necessarily what was popular.