ADR vs Spinal Fusion L4/L5

[Golf Pro FLA]

I have been denied coverage for both ADR and spinal fusion procedures,and am in the process of appealing. What i don't know is which surgery to go with. I have researched both positive and negatives of each and I personally feel that ADR is seems better for my situation because of my profession. I have spoken to surgeons that i've know for years that work with MLB and NFL team, and have discussed both options. I would love to hear feedback from people that have been in my situation. thanks!

Matt

[Justin]

Hi Matt,

Welcome to the Spine Patient Society.

There are many professional athletes that have had spine surgery with both spinal fusion and artificial disc replacement surgery. It's great that you have access to surgeons that frequently work with professional athletes in the MLB & NFL.

Over the last ~10 years helping Spine Patients online, I've personally come in contact with many professional athletes that have had artificial disc replacement surgery. Let me dig up their contact information and I will pass it along your way.

Once again, welcome. You can search our Forums in the upper right-hand corner for just about anything you are looking for relating to the spine.

I wish you the very best.

[JPJH]

I'm surprised you got turned down for fusion. I understand getting turned down for ADR as that is pretty common. Have you had a second or even third opinion? If so OK. If not there may be a good reason the insurance turned you down (other than them just not wanting to pay), like maybe there are other treatments you should try before getting surgery. Surgery should be the last resort.

JPJH

Cervical ADR /2 levels/M-6/ Barcelona 10.10

[Golf Pro FLA]

i have tried pretty much every non surgical treatment I could. The insurance company's reason for denying fusion was that they didn't think my vertebra was unstable enough. I have had a 2nd opinion from the Tampa Bay Rays orthopedic surgeon, and he agreed that i need surgery as well. I have a 3rd party company that is appealing my insurance company's decision. I'm told that these appeals usually go through...One thing is for sure, I'm getting worse and my pain is increasing.

[Cindylou]

i have tried pretty much every non surgical treatment I could. The insurance company's reason for denying fusion was that they didn't think my vertebra was unstable enough. I have had a 2nd opinion from the Tampa Bay Rays orthopedic surgeon, and he agreed that i need surgery as well. I have a 3rd party company that is appealing my insurance company's decision. I'm told that these appeals usually go through...One thing is for sure, I'm getting worse and my pain is increasing.

Golf Pro, I am so sorry to hear about you suffering low back issues, as well as your insurance not cooperating. This is "the new answer" from insurance companies, particularly relating to the new wave of fusion denials: vertebra are not unstable enough. It's a bunch of crap, but they still hold the power, unfortunately. It's good that you are getting these 2nd and 3rd opinions, especially since they are all agreeing that you need surgery of some sort. This will serve you well in your appeal process. Especially since you do something so physical, golf, for a living, I have to believe that somewhere in your appeal process you will see this turn around in your favor. I hope you can get your pain levels managed better and I want to wish you the best of luck during this stressful process. Cindylou

[Golf Pro FLA]

thanks for your response cindylou. I am going to try and up my meds a bit. I don't want to keep taking more and more percocet every day. I'm on 7.5/500. I want to see if they will bump it up to where i have less acetaminophen.

[JPJH]

OK, sounds like you did get additional opinions. Thanks for that info.. Well at this point you have to try the appeal process with the insurance company. I wish you all the best and hope you are succcessful.

JPJH

[Cindylou]

thanks for your response cindylou. I am going to try and up my meds a bit. I don't want to keep taking more and more percocet every day. I'm on 7.5/500. I want to see if they will bump it up to where i have less acetaminophen.

Also, fyi, you can request your Oxycodone to exclude the acetaminophen. I take Oxycodone HCI, 5 mg, and it contains zero acetaminophen. Definitely worth asking your doc about. You definitely want to get your pain managed as well as possible, in the interim. Good luck, Cindylou