Two Level ADR U.S. Pay out of Pocket

[Cynlite]

Hi and welcome!

When you have a minute, go over to the New Members Forum and introduce yourself to the group. Your intro will just get buried here in my thread

[Cynlite]

Dealing with The Barrow Institute has been a frustrating journey so far. They wouldn't let me set up an appointment until after the surgeon reviewed my Cervical MRI films and package (I understand that) but, it took 2 months to get into see him after they received the package. His office told me multiple times he uses the Mobi-C but, he informed me at the appointment he does not. He uses the ProDisc-C and wasn't a fan of it either. He recommended a one level fusion at C5-C6. That appointment was sort of a waste of time. So, the doctor referred me to their Mobi-C surgeon one month ago as I told him I was not interested in getting a fusion and wanted to look into ADR. The new surgeon's office would not let me set up an appointment until he reviewed my Lumbar and Thoracic MRI films. Okay, I don't like it but, I understand the reasoning. Problem was that the disc and report were sent to the first surgeon's office and they failed to send it over to the 2nd surgeon. I was chasing that problem down for about 4 days. I still have no idea if they sent it over because I took care of getting the MRI report to them. Now, I'm waiting for the 2nd surgeon to decide if he wants to see me. I'm still sitting around waiting without an appointment!

I sure wish I lived in Colorado, California or Texas right now! The Barrow Institute is the top facility in our state. I guess they are really busy and there isn't much else to choose from here!

2nd Update: Just called and the 2nd surgeon Dr. Chang who said he agreed with Dr. Porter regarding the fusion. I asked "So, you're saying he does not think I'm a candidate for ADR?" Her reply "Oh, let me put this back to him and ask. You do realize that your insurance will probably not cover the surgery!" I told her I'll cross that bridge when I get to it. It feels like I'm just spinning my tricycle wheels! Absolutely no feedback on the Lumbar and Thoracic MRI's either!

[colorado babe]

Originally Posted by Cynlite

Dealing with The Barrow Institute has been a frustrating journey so far. They wouldn't let me set up an appointment until after the surgeon reviewed my Cervical MRI films and package (I understand that) but, it took 2 months to get into see him after they received the package. His office told me multiple times he uses the Mobi-C but, he informed me at the appointment he does not. He uses the ProDisc-C and wasn't a fan of it either. He recommended a one level fusion at C5-C6. That appointment was sort of a waste of time. So, the doctor referred me to their Mobi-C surgeon one month ago as I told him I was not interested in getting a fusion and wanted to look into ADR. The new surgeon's office would not let me set up an appointment until he reviewed my Lumbar and Thoracic MRI films. Okay, I don't like it but, I understand the reasoning. Problem was that the disc and report were sent to the first surgeon's office and they failed to send it over to the 2nd surgeon. I was chasing that problem down for about 4 days. I still have no idea if they sent it over because I took care of getting the MRI report to them. Now, I'm waiting for the 2nd surgeon to decide if he wants to see me. I'm still sitting around waiting without an appointment!

I sure wish I lived in Colorado, California or Texas right now! The Barrow Institute is the top facility in our state. I guess they are really busy and there isn't much else to choose from here!

2nd Update: Just called and the 2nd surgeon Dr. Chang who said he agreed with Dr. Porter regarding the fusion. I asked "So, you're saying he does not think I'm a candidate for ADR?" Her reply "Oh, let me put this back to him and ask. You do realize that your insurance will probably not cover the surgery!" I told her I'll cross that bridge when I get to it. It feels like I'm just spinning my tricycle wheels! Absolutely no feedback on the Lumbar and Thoracic MRI's either!

Sounds like your getting the run around. I wish you lived in another state as well. Please keep us updated. Hopefully -- you will get some answer's soon.

[Cynlite]

The Barrow Institute's Mobi-C surgeon Dr. Chang determined I was not a Mobi-C candidate because of my prior minimally invasive surgeries so, he won't even allow me to set up an appointment to see him. It was like pulling teeth to get that answer! Dr. Porter at the Barrow Institute thinks I'm too old because I'm in my 50's. He will under perfect circumstances (i.e. healthy person in 20's or 30's) do the Pro-Disc C surgery. However, both the surgeons at Barrow agree that I should get the fusion surgery. No surprise there. This sadly is playing out exactly as I anticipated it would.

There are no other Mobi-C surgeons in my network in Arizona. I can either wait until January 2016 when I can change my insurance plan to continue fighting this fight in my state (I think that's a wasted effort) or go to Europe and pay cash for the surgery or find a more seasoned ADR surgeon in the U.S. that thinks I'm a candidate and pay cash for the surgery. I think this thread is just about dead but, before I end it, I'll see what Dr. Zeegers in Europe says about me being an ADR candidate. Dr. Bierstedt thinks I am a candidate for a two level cervical ADR surgery. Stay tuned ...

[scoop302]

I'm sorry to hear you are in this place. I asked my dr here that does ADR with mobi-c and pro discL, he said the biggest reasons not to do it are osteoporosis or allergies to metals. After that, he would look at some other minor things. During surgery he would be ready to do fusions if necessary.

[Cynlite]

It was good to hear that NJ Gene did so well with his 1 level cervical disc surgery in Texas! Cost excluding traveling expenses was $22,400 for a Mobi-C. He's another successful member of the Mobi-C club and I'm so hoping it stays that way! That was a very reasonable cost for the surgery from a very respected surgeon if anyone reading this is looking to have this surgery in the U.S.

My Mom passed last Friday so I've been pretty paralyzed physically and emotionally this last week. It is honestly the worst event I've experienced in my life. Emotional pain turns into physical pain for me so, I've been trying hard to be as calm as possible but, it's difficult. I wish I had my surgery planned already so I could use it to distract me and have something to look forward to but, as hard as I have tried to find the answer, my search is still not complete and as most on this site know, it's hard to do this when in pain.

I tried calling several other surgeons at the Barrow Institute but, their office staff was not very accommodating. I did find out that no surgeon at their main location does ADR after making a ton of calls and finally reaching someone in Administration who knew what was going on at the Institute. What a huge waste of time I have spent with this supposedly top notch spinal hospital! Four of their surgeons are listed on the Mobi-C site and some of the bios say they do ADRs but, I'd have to find one not at the main hospital location. Plus, none of them are advertising that they are Mobi-C doctors so, that doesn't give me a warm and fuzzy feeling.

I called my insurance company and told them I was gridlocked in their network because most of their neurosurgeons are at Barrow and most won't see me because of my prior surgeries. They said they were not surprised as they had heard this before! (Keep in mind, I have no hardware in me so, this is kind of surprising.) The insurance company said I could go to my primary care and have her request that I see a surgeon out of network. I asked if I could go out of state if approved and they said "yes." I asked if I could go out of country and they said "no." It's just another hoop to jump through and they could still say no to me so, I don't know if I'll go this route. I think I have to pick out the surgeon first so, it's a bit complicated. I am so tired of trying to find a surgeon in network and fighting the insurance battle. I'm six months into the process and really no further along in the U.S. with the exception of an offer to fuse my neck but, the surgeon telling me that he didn't think it would help me with much of my pain. So, I'm hoping I get some answers from Europe soon. After that, I'll know better what to do next.

[Cynlite]

I came across this data today when searching AGAIN about fusion surgery and how it makes surgeons rich and how it is under scrutiny for being medically unnecessary at times. "From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements." In the first link, you'll find a spreadsheet download for Excel. It will allow you to see some statistics on the surgeons in your area.

Tapping into controversial back surgeries - Page 2 - CBS News

I found this article to be disturbing. It's sad to me because when people agree to spinal fusion, they are in pain and easily convinced to have the surgery. The so called "golden standard" however, doesn't have a great track record for reducing pain from what I've read. Tapping into controversial back surgeries - Page 4 - CBS News

Below is a statement from Dr. Daniel Resnick, Vice Chair of Neurosurgery at the University of Wisconsin School of Medicine and President of the Congress of Neurological Surgeons.

"Dr. Resnick also emphasized that there are many cases where spinal fusions are clearly necessary. The procedure is widely accepted for treating major spinal deformities (like scoliosis), fractures, tumors, infections, and spondylolisthesis (slipped disc) in the lower back. But some of the nation's top spine surgeons say they rarely perform it for simple back pain, degenerated discs (or "degenerative disc disease"), stenosis (a narrowing of the spinal canal), or a herniated disc.

More than 480,000 spinal fusions are performed in U.S hospitals each year, making them more common than even hip replacements. The annual cost of these surgeries is more than $12 billion, according to the Agency for Healthcare Research and Quality. Experts disagree about how many may be unnecessary, but Dr. Richard Deyo, a critic of the procedure and professor at Oregon Health and Science University believes it could be as much as half. For Medicare and Medicaid patients, taxpayers foot the bill."

Info in spreadsheet they had for Texas Back Institute below. Note that Dr. Blumenthal and Dr. Zigler showed zero or "under eleven.":

[Cynlite]

I'm still waiting on my insurance company to make an exception and allow me to travel to Dr. Pettine in Colorado. Who the heck knows how that will shake out since insurance companies are just a pain to work with ...pun intended LOL. I'm grateful to my primary care for helping me to fight this battle. A good primary care doctor makes all the difference. Much to my dismay, my wonderful doctor of 10 years closed her practice and it took me two years and moving through several other doctors to find my current one. I'll just say it again...I'm grateful to her and her office!

Dr. Clavel recommended Dr. Chris Yeung in Arizona. He too is not in my network but, I was aware of him. The reason I didn't seek him out is because his office said he still uses the Prodisc. I would only consider the Mobi-C in the U.S. but, since I now know I need three levels done in my cervical spine, I have now ruled out the U.S. My challenge has been to try and find a U.S. based surgeon who will see me after I have surgery in Europe. It may not be necessary but, it's always good to have a back up plan. Hopefully, one of these surgeons will fit the bill and my insurance company will allow me to see them.

[Cynlite]

No surprise, the insurance company turned down my request to go see Dr. Pettine in Colorado. I'll have to appeal that decision and regroup. I swear, insurance companies sure do hinder the healing process. Even though Dr. Pettine is in their network in Colorado, they still decided I should stay in my backwards state for care! Frustrated today!

[scoop302]

Maybe your insurance company thinks you are going to make them pay for travel to get there. You have to be reasonable, they need to not pay out if the CEO is going to make his $20 mil this year. Think about all those house payments he has.