Stenum ADR - Recovery and Insurance

[Brian]

Hello, Everyone. I am new to the forum. I will be having a two-level M6 (L5-S1/L4-L5) ADR at Stenum in April and I was wondering if anyone else has had this procedure and what the likely recovery time will be. I am 28 yrs old, in very good physical condition (gym 5 times a week, running 4 times a week) and I am looking forward to getting back to these activities as soon as possible. I am also interested in the possibility of insurance reinbursement. I have BC/BS of Illinois, and have undergone several surgical and non-surgical interventions. Any help would be great. Thanks!

[Justin]

Hello, Everyone. I am new to the forum. I will be having a two-level M6 (L5-S1/L4-L5) ADR at Stenum in April and I was wondering if anyone else has had this procedure and what the likely recovery time will be. I am 28 yrs old, in very good physical condition (gym 5 times a week, running 4 times a week) and I am looking forward to getting back to these activities as soon as possible. I am also interested in the possibility of insurance reinbursement. I have BC/BS of Illinois, and have undergone several surgical and non-surgical interventions. Any help would be great. Thanks!

Hey Brian,

Welcome to the Spine Patient Society.

Sorry you need to be here at a young age. However, we have had a whole host of Spine Patients that have been treated at Stenum for their spine issues. If you search the SPS Forum for "Stenum," it should pull up a lot.

There's a lot of information in the Surgical Outcomes Forum, Surgical Outcomes, and there's a lot of reimbursement information in the Health Insurance Forum, Health Insurance.

You can also search SPS Member names...trkdoc714 (Bob, our Super Moderator, went to Stenum and was reimbursed), Ben, etc. are all success stories that were reimbursed as well.

Make yourself at home; we are here to help.

[Brian]

Thanks!

[rhatzy]

Brian,

I had L3-4 and L4-5 done 3 years ago at stenum, I had the maverick as the M6 wasn't available for the lumbar yet. I had a difficult recovery due to the fact that I had already had 2 other discectomies. It took me 5 months to get better. Since then, I have been virtually pain free and am flying as a Captain for American Airlines. I think it all depends on what condition your back is already in that determines the recovery. If all you have are bad discs, then you should be fine. Recovery just depends. A guy in my group at Stenum had L5-S1 done and he was fine in a week, no pain meds after he came off the epidural to a couple of people that still have problems but are better off. It is major surgery and there are risks. You just need to determine the risk you are willing to take. I had no other option as the ADR was the best and only option for me. And I'm glad I did it.

As for insurance, good luck. Start now with you r insurance company. Get a medical necessity letter from Stenum and just keep badgering your insurance company. My company wouldn't reimburse me, but it was the best $40,000 I ever spent.

There are many very good surgeons doing the M6. I think Stenum has been doing the M6 the longest and Ritter-Lang is one of the best. My experience a Stenum was great and I wouldn't hesitate to recommend them.



Mark

[trkdoc714]

Brian,

I had a two level lumbar surgery using the Maverick disc as well. As a matter of fact, Mark's success was one of the deciding factors that led me to them. I

was fortunate to get an appointment with Dr. Ritter-Lang in Atlanta for a comprehensive exam. Surgery was on March 27th and I was back to work on June 23rd. I've been mostly pain free since the 2 month mark.

The insurance reimbursement was a learning curve. Like Mark said, the letter of necessity is critical for the surgery as well as the days spent in the hospital afterward. Stenum will provide both if needed. Documentation of all of your previous doctors' visits with their notes and surgical notes from any surgeries should be presented as well.

A comparison of surgical options worked for my case. As a 2 level ALIF cost $110,000 US with a potential 6 month recovery period and the 2 level ADR cost $38,000 (I had a coupon, Mark) with a 3 month recovery a business case was easy to put together. Since the claim was filed after the successful surgery, an argument of unproven technology was a moot stance for them to take.

I hope this gives you some ideas for your claim/ appeal that lead to a successful reimbursement. As Mark said, even if you don't get reimbursed, it will be the best investment you can make.

Bob