[jss]

nornie,

I am so sorry to hear of Bob's injury. His story is a common one that is shared by many of us, including myself.

I won't bore you with the details of the accident(s). But in 2000 I had to have a fusion at C4/5 and then another in 2002 at C5/6. Things went well until January 2008. On September 21, 2009 I woke up with near debilitating neck pain (we were on vacation on Maui with our oldest and his family - I was 47). By two days later (we were on Waikiki) I was all but incapacitated with pain in my neck, left shoulder, arm and hand.

I would spend the next three months chained to my couch in debilitating pain. Immediately upon returning home (suburban Dallas) on Sept 25, I visited my doctor. An MRI showed a bulging disc at C6/7, an enormous osteophyte at C3/4, and the beginning stages of myelomalacia. ALL RESULTS OF THE PREVIOUS TWO FUSIONS.

On Nov 25, 2009 I had a double ADR with the Spinal Kinetics M6 at C3/4 and C6/7 with Dr Pablo Clavel of the Barcelona Spine Center at Quiron Hospital in Barcelona, Spain. I felt better when I woke up than I did when they put me to sleep (and they even neglected to give me pain medication). Since time I have completed two half-marathons, one full marathon (with a new personal best), and will be competing in a 100 mile bicycle race at the end of this month. I don't see how I could ask for more.

I am currently locked in an eight month battle with my insurance company for reimbursement for the surgery. They approved the predetermination for the same surgery with Dr Jack Zigler at the Texas Back Institute in 2008, but decided to deny the claim for reimbursement after surgery in Barcelona a year later. I am in the midst of my second appeal from a second denial (for a different reason). Because my pain was near 100% debilitating and because myelomalacia at the level I was developing it causes either quadriplegia or death in 100% of the cases, a protracted fight with my carrier (BCBS-TX) was not an option. Unfortunately, if you pursue ADR, you should be prepared to foot 100% of the cost. An approved pre-determination should not be confused with assurance of payment from your carrier.

For insurance, I would strongly encourage you to purchase Laurie Todd's book. (google "Laurie Todd") In her book she give a lot of tips on appealing your carrier's denials, and gives you her winning appeal to her carrier. The book and CD together are less than $40, and are a very wise investment for someone looking at ADR.

Good luck!

Jeff