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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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#1
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Any hard evidence I can show insurance that Prestige better than fusion?
Hello friends: Is there any hard core evidence that I can show my insurance company that proves that the prestige cervical disc outcomes are better than a regular fusion? They denied my ADR on the basis that there isn't enough evidence beyond just "theory" that proves that an ADR is better than fusion. Thank you! (I am in the USA) Or, is there a proven better artificial disc besides the Prestige?
Lee |
#2
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If you have to pay yourself, go to Germany, lower cost, more experienced doctors
Quote:
Sandy
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**Accidents, active life-style, always some back/neck pain controlled w/ibuphrofen 2004 excessive pain, x-ray, PT, MRI diagnosis cervical DDD **PM recommended, meds, PT, massage therapy, chiropractor, injections **Dec. 2007 numbness and weakness in left arm/thumb, x-rays, MRI, discs at C4-7 pushing on spinal cord, fusion or ADR out of country **April 7, 2008, discogram at C3-4, surgery 4 levels, Prodisc-C, Dr. Bertagnoli, Germany |
#3
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I can't remember if the Prestige has CE mark approval (Europe's equivalent to USA FDA's blessing) but if it has you should be able to dig out the report they submitted for their approval to show that the disk does work.
The answer to your second question is that there isn't a disk that has been proven to be substantially better than the others in a clinical trial or through an extensive use history. All we have is speculation, analysis based on speculation, and lots of marketing.
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Laura - L5S1 Charitee C5/6 and 6/7 Prodisc C Facet problems L4-S1 General joint hypermobility Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address "There are many Annapurnas in the lives of men" Maurice Herzog |
#4
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Hey there. I am currently getting an insurance appeal ready ahead of time (looks like I will be having prodisc with delamarter since the cost difference isn't AS much as I thought. I'd love to go to Bertagnoli but the travel will kill me). Anyway, Synthes, the manufacturer of the ProDisc, can give you literature/studies showing superiority of ProDisc to fusion. It's different for cervical than for lumbar obviously, or I would just share all the studies/citations I have accumulated. But look on their site and then call their "PAL" Patient Assistance Line...(too cute by half, I know. That's what they call it). Wishing you much luck.
Leora
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Large central L5-S1 herniation in late July 07 with progressive cauda equina symptoms. Laminectomy/discectomy on Sept 7 2007. Very difficult recovery. Still on disability, working 2 hrs/day from home in a chaise lounge Nerve issues in both legs an |
#5
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Leora,
If I were as close to Delamarter as you are I wouldn't consider going out of the country. You'll be fine. I'm not having any luck with insurance. Dr. B's charges are a flat rate, BC/BS wants an itemized, day by day, hour by hour!!, charge for each individual thing, like they do here. You know $100 for a pain med, etc., etc., Best wishes, will keep you in my thoughts and prayers. Sandy
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**Accidents, active life-style, always some back/neck pain controlled w/ibuphrofen 2004 excessive pain, x-ray, PT, MRI diagnosis cervical DDD **PM recommended, meds, PT, massage therapy, chiropractor, injections **Dec. 2007 numbness and weakness in left arm/thumb, x-rays, MRI, discs at C4-7 pushing on spinal cord, fusion or ADR out of country **April 7, 2008, discogram at C3-4, surgery 4 levels, Prodisc-C, Dr. Bertagnoli, Germany |
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