[Nichole]

My name is Nichole, a 32 year old single mother living in Seattle, WA. Approximately 2 � years ago I sustained an injury to my lower back during a softball game, which left me unable to move for several days. After numerous visits to the doctor I was informed that I had herniated my L5-S1 disc and there is also a tear in the annulus which would never heal. I underwent 2 MRI�s, 3 spinal injections, visited 3 separate physical therapy clinics, and suffered through 2 Discograms. None of these minimized my pain which brought me to Dr. Schwaegler for an Orthopedic surgery consultation. I was informed that as of that day the only thing that could be done was to fuse the spine, which, in time, I would lose the mobility in my back and could experience several other complications along the way. My doctor agreed I both agreed that at my age it was a sad choice. By the time I was 37, I could possibly be moving around like I was 90.

After much discussion about the fusion he told me of a disc replacement procedure that they had been doing in Europe for the past 17 years called the Artificial Disc Replacement surgery. Europeans have had great success with this surgery. Both in the short term as well as long term. Dr. Schwaegler stated that I was a perfect candidate for this procedure due to age, weight and type of injury but unfortunately it had not been approved by the FDA yet....

After doing numerous hours of research on this, following the FDA on a monthly basis and contacting Depuy (the manufacturer of the Charite disc), I received and email in November of 2004. The FDA approved the procedure! The manufacturer of the disc sent me an e-mail personally due to the interest I had shown in having this done, to give me the good news.

I have been on a daily regiment of medications since the injury to maintain anything resembling a normal life. If I forget my medication for even one day, I am immobile and am in so much pain that sleep is not an option. I am unable to stand long enough to do dishes, laundry, normal day to day functions, and the hardest limitation is playing with my 12-year-old son.

Due to the procedure being approved by the FDA it is no longer an �experimental� procedure. However, as Dr. Schwaeglers patient representative has tried to get authorization for me to have this surgery and my insurance company, Regene, is denying this surgery stating that the procedure is �experimental�. They do not want to pay for this surgery. However if I was to go out of state they would pay at 80% and without authorization. I was also very confused when I was told that a very small insurance company in Bellevue is approving their patients to have this surgery but a big insurance company like Regence is not.

The problem is that the insurance companies do not look at these issues from a patients prospective. I can go ahead and have the spinal fusion and my insurance will pay 100% of the costs to have that surgery. In approving me to have a spinal fusion they also �silently� approve all of the medical complications that will come later in life for me due to having the spinal fusion, such as fusions in the rest of my vertebrae to make up for the loss of mobility in the level that would be fused.

The reason that I am writing this letter to you, is I know that there are numerous patients out there that are just waiting, in sever pain for the insurance companies to quit playing their denial game and allow the patients to have this surgery. At some point this surgery will be approved by all insurance companies as the Total Knee replacement has and the Total Hip replacement surgery.

I obviously have a personal interest in helping this process along. I would like to play ball with my son, take the dog for a walk, sit in a chair for more that 20 minutes at a time, and just have a normal quality of life.

If anyone can give some advice on how to get my insurance to cover this please let me know. I dont know how much longer I can hold on.

Thank you.