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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#1
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Well I don't live in the USA, but from what I'm reading on these pages it looks as if USA citizen's are getting a hard deal both from the surgeons and from the insurance companies. The insurance companies look as if they do not want to spend the proper amount of money in giving extra days in hospital and follow-up for ADR treatment,and it looks as if the surgeons are having to go along with that because that's the only way they're going to get paid. It would seem also that there is a lot of lack of knowledge about aftercare because it's a new procedure.
From what I can gather ADR has been approved so I don't know why the insurance companies are declining proper care for their policyholders. I would think that the way ahead for this is to go public in the press, those of you that are attending the New York symposium which Mark is running surely can get some quotes from the "World's Leading Spine Specialists" and push that at the press. I don't know how you do the publicity thing in the USA but there's enough brains between the lot of you to sort something out. A lot of people have done a lot of begging to the insurance companies -- -- -- somehow you've got to get what you deserve and not what they would like to give you -- -- -- you have been given the knowledge and expertise on this board, I would ask the right questions at the right place at the right time and have the press present. Best, Alastair
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ADR Munich 26th July 2002 L5/S1. Aged 82 now Your best asset is your health My story is here http://www.adrsupport.org/alastair.html Thank goodness for Dr Zeegers I am painfree I am here to help,I live in the UK I now run the UK spine site and can be contacted at www.adrsupportuk.com/ |
#2
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Maybe it would help the "cause" by inviting NYC TV /NYT/NY Post print reporters to cover the event. It's unique enough to pique interest.
Well-designed longitudinal studies are scarce in the literature and one European retrospective is damning but poor in research design/interp. (I think). At least insurers know with good long-term statisical confidence that fusion can really suck in the long-term. Go figure.
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand. |
#3
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Alastair,
After reading a post from you re: post hospital care I called and asked to speak to my case manager. She said that my doctor only asked for one day and that is what I got with my authorization. I told her that what I know people are requiring 2-5 days. She said it is her job to call the hospital to see how I am doing and if I need more time she will authorize it. It has to do with the drugs I need for pain. She said, Hospitalization is not an excuse for a poor support team when you get out. It is up to the doctors not the insurance company as to how long you stay in the hospital in US the insurance companies keep a close eye on what is going on. Are the Doctors on your side of this issue or on the side of the insurance companys? To me that is the real question.
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Paulette ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005 L5-S1 DDD Diagnosis 12/04 T-12 Compression Fracture 10/04 C-7 Spines Process Fracture 5/99 http://prodisc2.blogspot.com/ You are my Rock God in you I can do anything |
#4
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The insurance companies don't want to pay for extra days in the hospital and post op care? Heck, most all of us can't even get the surgery approved. These other details are not even an issue at this point.
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*10 plus years of back pain *'99 first MRI shows L4-5 bulge *'04 MRI shows L4-5 grade 3 annular tear & rupture with moderate DDD *'05 Discogram shows concordant pain at L4-5 *8/18/05 scheduled ADR surgery participant in Kineflex/Charite study |
#5
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Well coverage in theory.
When Drs. don't request cash up front for multiple level lumbar procedures, that will signify coverage in a meaningful fashion.
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Cervical ADR of interest. |
#6
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I agree with Patrick.
I'm not worried about extra days in hospital care after surgery. Most likely, a long hospital stay would not be needed. I would just like to get the benefits of getting the procedure I need after paying all these year's for my insurance and my family's insurance. Brady
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15+ yrs chronic low back pain. L5/S1 DDD |
#7
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Quote:
I was in the hospital for ten days and I was really thankful that I was in the hospital that long. I am young and fit, and I personally wouldn't have been able / comfortable leaving the hospital after 3 days. I appreciated the longer stay in the hospital--a 2-level is a big procedure and a 3-level is no walk in the park. Justin |
#8
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We need to remember that we are all at different stages in our ADR research and posses, some father along than others. Through these postings I am learning to be more proactive with this posses. I also feel it is important to have a specialist that is aware of the ADR complications and what to look for. My doctor that authorized one day in the hospital has no ADR under his belt. This info has come from the training he received in Nov'O4. So what are the US doctors learning about post op needs for ADR patients? FYI he will not be doing my ADR!
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Paulette ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005 L5-S1 DDD Diagnosis 12/04 T-12 Compression Fracture 10/04 C-7 Spines Process Fracture 5/99 http://prodisc2.blogspot.com/ You are my Rock God in you I can do anything |
#9
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I'm so paranoid that I'd prefer a longer vs. shorter stay b/c of DVT's. Never figured out how anyone can sleep in a hospital.
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand. |
#10
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I am new to this site. I am in the Long Island New York area, and have Oxford Freedom select plan. I have DDD L5-S1 & DDD L4-L5 and am a candidate for ADR.
I have already been denied by Oxford "not medically necessary" I went through the 1st level appeal process, same thing denied by Oxford "not medically necessary" I went through the send level appeal process, same thing denied, "not medically necessary". Went through the Greivance review board, same thing denied. Then finally, Had to go through an External level appeal process, throught the State Insurance Department, they ultimatley came back and"DENIED" "not medically necessary". I have also written the local news station, and currently waiting for a reply. I am at my wits end. I am willing to go as far as changing Insurance Companies. I have heard that Aetna (do not know which plan) is covering this ADR. If anyone has any information please let me know. Thank you Sue ----- DDD L5-S1 DDD L4-L5 3 levels of appeals "denied" external level appeals "denied" |
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