Hey Y'all (Upcoming Fusion at L4/L5 & L5/S1)

[rlmdodge]

Just joined this message board late in December. Have a question for you. I was originally set-up to have a fusion @ s1-l5 and disc replacement of l5-l4. My insurance company (UHC) denied the adr but approved the fusion too late in the year for surgery. After research and soul searching I have decided to go with the fusion. So now my coverage changed 1/1/11 to BCBS of IL. I never imagined that I would have problems getting a fusion approved but now I am reading that BCBS of NC is denying fusions? This causes me to be concerned that BCBS IL may adopt the same policy? Now I am concerned I may never get rid of my back pain since ADR is not readily approved and fusions may be on the way out?

Thanks for any insight or encourage you can give!

Thanks!

Becky

[KBear]

Becky,
I would have your doctor try to get pre-approval on the ADR and fusion again, as you may get it. From my understanding some of the insurance companies are denying fusion in favor of ADR. So you never know until you try. Also, generally when they deny ADR they recommend fusion instead, so this could be the way to ask for what you wanted (ADR and fusion) and if they say no, you still get what you want (the fusions).
Best of Luck,
Kathy

[Justin]

Hi Becky,

Welome to the Spine Patient Society.

In terms of your insurance company canceling your fusion, I wouldn't worry about them canceling your surgery. UHC is really good about covering fusions; however, as I'm sure you've noticed, they do not cover artificial disc replacement surgery.

The denial of fusions in North Carolina by Blue Cross is being discussed feverishly, as surgeons do not want other insurance companies to adopt this new policy. Personally, I believe you are OK with United Healthcare at this time.

When is your operation? Please let us know if you need anything--we are here to support you.

[Cindylou]

Hi Becky,

I also wanted to welcome you. Have you put in your request for surgery with your new insurance provider? You probably have, but if not, it goes without saying to do so as earnestly as possible. I think you will be fine getting coverage, but just get on it, if you haven't already, and try "not to borrow trouble" as my Grandma always used to say. Don't borrow trouble is the actual saying. There is a lot of wisdom in that saying. Keep us posted, as we do care. Good luck, Cindylou

[Justin]

Hey Becky,

How are things on the insurance front? I hope you were able to move forward with surgery.