[Artificial Disc Replacement / Lumbar] New and Looking for Help (ProDisc L4-L5 & Fusion L5-S1)

[AmyBB]

Last August, after years of pain, I was finally diagnosed with DDD and a very bad disc at L4/5 and also L5/S1. After 10 months researching procedures and searching for a very well educated and experience doctor I finally had a hybrid surgery, just 2 weeks ago.
During that 10 months I was "fighting" with my insurance. It wasn't until a week before surgery that I found Laurie Todd's book and realized that I had never actually written an appeal, but now we are working hard on one.
These boards are filled with info, I just don't know where to start. But I am looking for people that have had their insurance pay for their surgery. I would love to talk to you.
For those that want more info on how I came to the conclusion of the product and surgeon feel free to ask. One huge help I had was a close friend that actually works in the industry. I didn't go with his product, but he was able to steer me in the right direction.

[Greg]

Last August, after years of pain, I was finally diagnosed with DDD and a very bad disc at L4/5 and also L5/S1. After 10 months researching procedures and searching for a very well educated and experience doctor I finally had a hybrid surgery, just 2 weeks ago.
During that 10 months I was "fighting" with my insurance. It wasn't until a week before surgery that I found Laurie Todd's book and realized that I had never actually written an appeal, but now we are working hard on one.
These boards are filled with info, I just don't know where to start. But I am looking for people that have had their insurance pay for their surgery. I would love to talk to you.
For those that want more info on how I came to the conclusion of the product and surgeon feel free to ask. One huge help I had was a close friend that actually works in the industry. I didn't go with his product, but he was able to steer me in the right direction.

Amy,

to the site and congratulations on getting your surgery. If you follow Laurie Todd's advice to the tee and put the time and effort and sweat into those appeals you should have a fighting chance. What insurance do you have? I'm not sure where but I know theres someone's explanation of benefits letter from BCBS showing reimburement for ADR in Germany. I wanted a hybrid surgery so bad (I had same condition as you) but I couldnt fight the insurance any longer...especially considering they were now denying me for fusion....so I had to opt for a 2 level ALIF and not the hybrid I desperately wanted.....long story on getting them to pay, we'll talk about that a different time or just search for threads I've started. There are several people who have fought the insurance in this community and won; hopefully they'll buzz in but keep searching and you'll probably find their posts.

How are you doing with your recovery? I know its early on but do you feel like it may be a success? I know you'll find the answers your looking for on this site. This is such a fantastic place full of caring, knowleged, helpful, people who have plenty of opinions and experiences to share....not to mention a whole lot of information here about conditions and treatments and studies/articles. So welcome and feel free to make yourself at home.

Oh, and if you are fighting the insurance it would be worth the few bucks to buy Laurie Todd's book on writing appeals (if you haven't alreadt) as thats your ticket to success in provnig your insurance that they were comepletly wrong in their decision of denying the only appropriate treatment to fix your condition.....GOOD LUCK

[AmyBB]

Greg~

Thanks for the quick response and welcome. Yes, I did finally get my hands on Laurie Todd's book just a week before my surgery. My surgery was a day before yours. I am doing well. My one disc had a whole in it and the other was very depleted so between the 2 I got a bit of a "lift" as well. The stretching of the muscles has caused some temporary pain, but other than that I am doing ok.
We have Lifewise insurance, I think the big umbrella is Premera.
I take it we now have matching scars across our stomachs too. Not pleasant, but not as bad as I had imagined. Unlike you I didn't have any accidents only wear and tear. I stay pretty physically active and have coached my kids as well. I guess they just got wore down due to my DDD.
How is the healing process going for you? It's my fusion that has me laying low the next 4 weeks. I assume you are under the same orders. I have dealt with pain for so long, that I am following doctors orders to a tee. I am done with living in pain, although the sitting still is killing me.
THanks again for the warm welcome.
Amy

[Greg]

Greg~

Thanks for the quick response and welcome. Yes, I did finally get my hands on Laurie Todd's book just a week before my surgery. My surgery was a day before yours. I am doing well. My one disc had a whole in it and the other was very depleted so between the 2 I got a bit of a "lift" as well. The stretching of the muscles has caused some temporary pain, but other than that I am doing ok.
We have Lifewise insurance, I think the big umbrella is Premera.
I take it we now have matching scars across our stomachs too. Not pleasant, but not as bad as I had imagined. Unlike you I didn't have any accidents only wear and tear. I stay pretty physically active and have coached my kids as well. I guess they just got wore down due to my DDD.
How is the healing process going for you? It's my fusion that has me laying low the next 4 weeks. I assume you are under the same orders. I have dealt with pain for so long, that I am following doctors orders to a tee. I am done with living in pain, although the sitting still is killing me.
THanks again for the warm welcome.
Amy

Amy,

It is my honor and great pleasure to be the first to welcome you to the family and share my experience. We almosy had the same procedure on almost the same day....kinda crazy....almost I think the stretching pain has gone away as well. The majority of the back pain I get from the surgery is down by my tailbone (around S1 I would guess) which isn't too bad as long as I do nothing But holy cow, if I straighten my back or lean back or rotate my pelvis to do so.....YOUCH! Doing nothing is the hard part and I sure feel it after too much activity. I've got a seperate issue that is making this recovery a lot worse than it should be. My sacroilliac joints have gotten horribly worse (I am hoping due to irritation to the S1 nerve roots during surgery and will go away soon) and I cant sit for more than a few minutes without the off to the side low back (buttock) pain that fires up the leg pain. So basically I try to spend most of my time laying on my side as thats the only safe thing for me to do that wont irritate anything. As long as I do that the recovery isn't too bad. I guess we do have matching scars now....theres a picture of mine in my recovery thread To All Greg's Supporters -- Fusion (ALIF), L4/L5 & L5/S1 But I am doing my best to follow the doctors orders, get my walking done (several short trips to equal half mile) stretches, and wearing my Bone-growth-stimulator made by Orthofix for 2 hours a day. Do you have a device like this to wear? The studies done on it showed people who had fusions and wore this device 2 hours a day for 3-4 months had a 40% greater chance of a solid fusion and it almost cuts the time to fuse in half Here's a link to their site explaining about it if you dont use one. I would HIGHLY recommend it after all I've researched about it. Spinal-Stim for spinal fusion is a noninvasive electromagnetic bone growth stimulator

They did a study on people who had a fusion operation that after 5 years they had not fused. They wore this device as instructed and I think 35-40% of those people now had a solid fusion....that is awesome If you fracture a bone your body emits a very minute electromagnetic field around the fracture and your brain sees that signal to send lots of blood to the site and to repair and regrow the bone. This device turns that signal on and tells your body to fuse the bones and it really does. Sorry to go on about this but I feel very strongly about the success of this product and think any fusion patient should use it

I had several accidents and bad skateboarding falls but I really dont think they had anything to do with my DDD which caused the herniations. My discs were bulging out the center from dying out and weren't like a ruptured disc where it pops out to the side. They herniated out from the wear and tear. I have always been a go-go-go person who was constantly busy as hell and never had free time. Always been super physically active (kayaking, canoing, camping, hiking, skateboarding, watersports, beach sports) reason why I have the worlds fastest metabolism but have abused my back since 9 or 10 years old doing way more than I should. My lifting habits werent good when I was younger (which I am awesome at always squatting to pick something up now) and working like a donkey since I was a kid I think was the main cause of my DDD and herniations. Being such an active person pre-op has made it very hard to "rest and relax" post-op. I didn't really know how to do that a couple weeks ago

I havent heard of those insurance companies so I have no information about people succeeding with an ADR appeal or a hybrid. But if you have Laurie Todd's book and the will to fight to the death than I have full confidence in you. How is the appeal going? Have you sent any letters yet or are you just starting? I googled around during my appeal fight and found some very thorough appeals people had written to help give me ideas.....might be of help

[AmyBB]

We don't have matching scars. Mine runs NE to SW across my stomach and is 7 inches. Looks like I was in a sword fight. That's my story and I'm sticking to it. I do remember the one doctor telling me that the ADR takes up a ton more space getting it in.

The appeal is coming along really good. My mother in law is helping me and she is quite the go getter. We have worked on it for a few days now and should hopefully have it done by a week or so. It's a lot to do getting into it, but once you get going, it's kinda fun. I haven't googled appeals, so I am going to try that. Is there a thread on here that talks about people getting insurance to pay? I have never been good at these boards.

I just read your story. You had awful pain. I am so sorry. There was one time in the hospital that they couldn't get on top of my pain, but after that I was good to go. Nothing like what you went through.

Although leading up to surgery I was doing pretty good. As a matter of fact we took a 3 day family vacation to a roller coaster park. I was running through the park and riding rides. Medicated of course, but doing it. I figured i would send this discs out with a bang!! I was super nervous about the surgery and didn't want to think about it. At one point my son had to give me a piggy back ride because I wasn't keeping up. My daughter was pushing me up a hill and encouraging me another time. But it's because we run from ride to ride and see how many we can hit in a day. That day....14.

After surgery the doctor told me my one disc had a hole in it. Describing it he held his hand to about the size of a nickel or quarter. He said there was nothing inside at all.

I told him my theory must have worked. I was told that the goo keeps shooting out onto nerves. So I figured if I kept going, doing and living through the excruciating pain eventually there would be no more goo. Then I would keep going after that so no goo would build up. I am not sure he bought my theory, but in the end I was only on 2-3 pain pills a day and riding coasters, so it must have worked. It probably wasn't the best medical decision I have made to date, but whatever.

That Spinal Stim looks interesting. I am going to ask my doctor about it. I like that if they didn't fuse, they still have the chance to make the fusion work.

My best friends husband works for a company that makes these devices. He had doctors calling me from all over. I must have talked to 15 doctors on the phone getting their opinions on things. The big question I had was "how does a fusion not work?" First off I learned the ALIF is the best you can get and the rest comes from not allowing the bone to fuse. People get anxious and do too much to fast because they feel good. Still I was freaked out about non union, as it sometimes just happens, so the product you mentioned does bring me relief to know that there is something out there than can help with that. GREAT TIP!

I get that same leg pain that you are talking about. My doctor didn't even blink an eye when I mentioned it. He said that was the pain from the stretching. those nerves are angry and stretched as well. So as I sit here right now, in pain, I keep thinking this will go away. Which I hope it does because it's not pleasant.

I also saw you mention a pain down close to the incision and it felt like a bruise... I have that too. Even today my leg feels like I bruised it. not sure what all that is about.

Off to figure out these boards.

Amy

[Greg]

Well damn.....7 inches I guess the doc was right about ADR needing some room. Here is a link to the "Health Insurance" Sub-Forum of the site. Thats where you'll find a lot of stuff about insurances, approval letters, lots ot tips from Laurie Todd, etc, etc, etc, Health Insurance

I love that you went out with a bang on your discs at the amusement park. 14 rides is a pretty good number. I used to have a gold level season pass for all Paramount parks and we would get in on days for just season pass holders or get in a few hours ealrier than everyone else. So we would go to the parks ALL THE TIME and when the parks were dead. I tried to set a record at Carowinds in Charlotte, NC where I rode "Top Gun" 32 consecutive times in a row (and I had the front seat EVERY TIME). On that particular trip it was within a couple weeks befor the park closed so all the summer visitors were back in school and we had the park pretty much to ourselves.....well I think there was 17 other people but who cares

I like your "Goo" theory Seems like it would put your vertebrae pretty close to being bone-on-bone though. Oh well, disc arent there anymore to have to worry about or even have a theory

Please do ask your doctor about the Spinal Stim. People hadnt fused for 5 YEARS and this device did the trick. Thats got to be the proof there that it works. If you havent fused at 5 years post-op I think its safe to say you aint gonna fuse. So this device has got the walk to back up the talk And as it goes for the ADR you have, you still need to embed the keel of the device into your vertebrae so thats gotta add some more value to it there. What ADR did you have implanted?

Doctors tend to not even be phased when a patient presenting back pain claims leg pain as well (this is just my opinion and doesnt reflect everyone....but you know what I was trying to say). They see a herniated disc and DDD well then that must be the answer to all the pain. Which in most cases is the truth but I was a little more complex than that. So do you have back pain different from the surgical pain that is not centered in the back but off to one side several inches and lower more like in the buttocks. Whenever I get that pain, thats when the leg pain, tingling, numbness, etc come into play. It took a befuddled and very confused pain management doctor to realize part of my issues were coming from the sacroilliac joint......cause all the other epidural steroid injections from L4-S1 didn't work. And thats when I pointed out where the pain was it was way off to the side.....not on the spine. Hopefully you dont have sacro issues

I think the bruising pain came from the fact that they had to move a lot of stuff around and take some stuff out to get a good open working area (maybe 20-30 feet of intestines ....but what do I know) so I think that as we have surgical pain from everything else being touched and moved we probably have surgical pain from the movement of those organs or the intestines not being put back in the exact spot. It seems to me that maybe some intestines are a little bundled at the pain site and maybe thats why it hurts. Hell, if I eat enough and have enough "shift changes" in the intestinal area that hopefully they will work themselves back to a nice normal home. I just keep doing stretches to try and work out the soreness.

See.....here we are at 2, 3, almost 4 o'clock in the morning trying to occupy our time because spine surgery recovery messes with your internal clock to where I dont have a sleeping schedule anymore. I just sleep when I can finally pass out!



Did that make you sleepy? New test I'm doing...............at least you can see how bored I am

[KBear]

Let's see if I can remember everything that came to mind while reading all that..... First, Welcome AmyBB! It's great to hear that your recovery is going good and you are on your way to a pain free life! On the leg pain, I never had leg pain prior to surgery, but oh my after it was there badly. It did go away eventually; but pretty sure it is from the stretching of the muscles.
Is your health insurance through an employer or a self employed policy? Ours is self employed, which means it sucks and costs a fortune. Seems like people with employer coverage are more able to get ADR covered than the self employed. I have also heard that if you go to the employer and petition for them to pay, that they can make (or at least ask) the insurer to cover it. Not sure how all that works, but the employer apparently has some say in coverage. I appealed twice and gave up, was in too much pain to wait. I went into a clinical trial.
I love roller coasters, sounds like you went out with a bang! I wonder if I will ever be able to ride one again? Not sure if I will or will be willing to risk injury.
Greg- I had no idea how the bone stimulaters worked, never really thought about it; but that is way cool. I would definitely wear one for 'insurance' on the bone growth. Never hurts to be over cautious.

Once again, welcome to the site and good luck with the appeal!
Kathy

[AmyBB]

Kathy-
We have are self employed so we are on our own. We have been denied 3 times, we actually 5 if you count the other doctors that also appealed. We just won't accept no for an answer.
This is it, our final appeal. I tried to get it done before surgery, but the ball kept getting dropped and not by us.
I tried to get into the Nuvasive clinical trial, but that didn't end up panning out. It looks like you are happy with the disc you chose. What is the name of the company that makes the Active L disc?

Greg, I am still sifting through the Health Insurance Files. Thanks for the tips.

Amy

[KBear]

Kathy-
We have are self employed so we are on our own. We have been denied 3 times, we actually 5 if you count the other doctors that also appealed. We just won't accept no for an answer.
This is it, our final appeal. I tried to get it done before surgery, but the ball kept getting dropped and not by us.
I tried to get into the Nuvasive clinical trial, but that didn't end up panning out. It looks like you are happy with the disc you chose. What is the name of the company that makes the Active L disc?

Greg, I am still sifting through the Health Insurance Files. Thanks for the tips.

Amy

There aren't a lot of self employed policy people on here, but a few. I went into a clinical trial to get my surgery, however they did bill my insurance for it and my insurer actually paid 10 or 15K toward my ADR This stunned me seeing as they denied me repeatedly... even using my age as a reason, saying that I am so young and there is no long term data on ADR, so who knows if it will last. Pretty sad, but I have no idea who makes the Active L.... will have to look into that, sure I have the information somewhere.

[Justin]

Last August, after years of pain, I was finally diagnosed with DDD and a very bad disc at L4/5 and also L5/S1. After 10 months researching procedures and searching for a very well educated and experience doctor I finally had a hybrid surgery, just 2 weeks ago.
During that 10 months I was "fighting" with my insurance. It wasn't until a week before surgery that I found Laurie Todd's book and realized that I had never actually written an appeal, but now we are working hard on one.
These boards are filled with info, I just don't know where to start. But I am looking for people that have had their insurance pay for their surgery. I would love to talk to you.
For those that want more info on how I came to the conclusion of the product and surgeon feel free to ask. One huge help I had was a close friend that actually works in the industry. I didn't go with his product, but he was able to steer me in the right direction.

Welcome Amy. What type of hybrid surgery did you have at L4-L5 & L5-S1? Good luck with your insurance battle.