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Artificial Disk Replacement

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:23 AM in Neck Pain: Cervical
So Ive been reading about ACDF daily for almost 2 weeks, everything I can find, even new procedures that do the surgery endoscopically, where they put a band aid on your "entry" point and send you home. One article I read was from the UK where a woman had disk replacement surgery, something she got done for free under thier health care system, and she is doing wonderfully. I understand that insurance companies wont pay for this here in the US, and I am assuming that it is because of the lack of FDA approval? Some of the articles Ive read are a bit dated so Im not sure that the information is current. Anyone have any ideas about this?
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Comments

  • Check with your insurance company because some do cover the cost. There are a couple ADR's approved by the FDA in the States. I just had and ADR put in 3 weeks ago (see your PM)and all is well. I can also tell you this that for the cervical region the FDA has only approved the surgery for a single level.

    Rob
  • aetown- Like Rob said check with your insurance company. I know that there are a couple of insurances that are covering only single ADRs. United Health, Cigna, and just heard BCBS, of course there are different groups within these insurances. You just have to find out. There are also several FDA trials that are going on and this is all done for free if you can get into one. Read the fine print though some pts get ADRs and others fusions. You don't know what you are getting until after the surgery. Try this web site adrsupport.com most memebers have gotten ADRs.

    Clarissa
  • Just an FYI, my insurance company is BCBS.

    Rob
  • Too bad more insurance companies wont approve cervical ADR. My NS has a buddy who does them at Walter Reed for those in the military. He has done a butt load of them and within two weeks the patients are back overseas.
  • I know the charite disk is approved. My friend traveled from California to have it done by a doctor in Colorado, Dr. Ken Pettine. The guy is involved in a bunch of research and so has access to all sorts of artificial disks and other technology currently available only overseas. My friend had a great experience with him, has kept his full range of motion and had an extremely short recovery time - like a couple weeks.

    The guy's website is rmsas.com. Something to check out at least.
  • hey there aetown. I am a candidate for ADR, and I will probably be going for it. There are about 10 orthopedists doing this surgery in the Bay Area, where I live. Check out the Norther California Spine Institute web site...these are the guys who started ADR in the area. It is now approved by the FDA. It is called a Medtronic Prestige Disc. There are others in the San Francisco area. Let me know how things go or anything new you discover. Some insurance folks are allowing it, but as in my case, I have to do the research to convince them. Good luck.
  • I appreciate all the info Ive seen since posting here, Thanks!

    One thing Ive noticed that seems to be a theme here is that they are doing the replacements for those of us who need 1 level done, figures cause I need 2 lol... But Im still searching and checking out everything suggested here, THANX!
  • That's not exactly true. It depends on the Dr. My husband's co-worker has two herniated disc and one bulge in his lumbar. He is going to get one ADR and a laminectomy in November. There are also hybrids. That is where you get one fusion and an ADR.

    Clarissa
  • My NS said I was the perfect candidate for ADR. The problem was I simply could not wait. The disc came apart and I was 9/10 to 10/10 in extreme pain. I was put in the hospital for pain mamagement and the drugs did not touch it. I needed the surgery ASAP and could not wait for approval. Oh well...
  • Lumbar ADR's have been approved for multiple levels but in the cervical arena ADR has not been approved.

    Rob
  • My insurance is Cigna and they have approved my 3-level ACDF.
  • Frustrated- Can you at least get one ADR and fuse what ever other levels you have?

    It is something to think about. I have always said my first choice is an ADR but in an emergency I would get a fusion.

    I hope that you find some kind of pain relief soon.

    Clarissa
  • I wish I could have, but I could not wait at all. The pain was too bad. The did the fusion ASAP.
  • The same may end up happening with me cath. Do you have ddd and multiple herniations? I hope the surgery goes well. Please keep in touch and let me know how things go. But, they are considering ADR with me because my degeneration is so bad. We shall see.
  • Hi Rob-

    I have been fighting CareFirst BCBS of MD since October 17 to approve ACD w/ ADR. I have been in pain since May 23. Went thru 4 months of PT covered by BCBS and pain returned 13 days following completion. Got an MRI (x-ray from May only showed small narrowing of the c5/c6 disc space) on October 15th. The MRI showed c5/c6 disc herniation resting in my spinal cord. I have all the typical shoulder and arm pains but have managed to control them with prendisone and Lyrica. I hate being on the meds but am determined to get ADR. I filed a complaint with the state Insurance Administration and included 88 double-sided pages of documentation. CareFirst BCBS stuck with their initial determination as the procedure is Experimental/Investigational. It blows my mind that they are so unreasonable. The case is now being sent to an independent review organization by the Insurance Administration. Based on their determination, they can order CareFirst BCBS to cover the procedure but they have up to 30 days to appeal. The crazy thing is the procedure is being changed from a Category III CPT code (emerging technology) to a Category I CPT code procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. The change takes place on January 1. My problem with waiting is 1) want to avoid permanent nerve damage 2) my caregivers following the surgery are leaving the country for two months on January 7th.

    How did you get it approved and how long did you need help following your surgery? Can you briefly compare the fusion recovery vs. the ADR recovery?

    I am a 38 year old self-employed (with no disability policy) female. I am in reasonably good shape. I was physically active before the problems began. I want to move on and get back to being me. I miss my workouts physically and mentally.

    Thanks for your help.
  • So you can have a cervical fusion and get a ADR above or below, that is if you insurance co to pay for it. How about medicare I know anthem BCBS is a bear. Does anyone know about BCBS of Virginia.
  • I had a Prestige ADR at C5-6 almost 2 months ago. My insurance (Patient Choice)paid for it. The Prestige (by Medtronic) has been FDA approved since fall of last year but a lot of insurance companies still consider it investigational because there isn't long term data in the US. I used to have Medica and they didn't cover the surgery, I started the appeals process but then ended up switching jobs and insurance companies.

    Have your MD's office put in a request for the surgery to your insurance company. If they deny it, they will send you your appeal rights. Usually there are 2 levels of appeals that are handeled by an RN or medical director at the insurance company. After that you get to have a hearing and then go to an outside reviewer and then if that doesn't work you can go to the attorney general. At least that is how it is in MN. I searched online and went to the ADR websites and they had info for what to write in letters to your insurance company. I wrote letters, had my surgeon write letters and sent data.

    Make sure your MD explains why this would be a better fit for you than ACDF. For me I am only 26 so that was big (a lot of insurance companies are more willing to approve for younger people). Also, he did a cost comparison, he explained that I didn't need any PT, brace, etc. and I would be fully recovered in 2 months vs. 6-12 months. You just have to be persistent.

    One last thing about the insurance thing, make sure you read all of the denials they send, one of my reviews was done by a family practice MD. So when I appealed the next time I requested that a neurosurgeon, a spine surgeon or a surgeon at the very least review it. They granted that.

    I switched insurances so I don't know how it would have turned out but I think I would have stayed on them long enough to get it approved! They count on people not following through because it is frustrating and long and drawn out. I had my surgery and it is more than worth it! Dr. Kevin Mullaney has changed my life with this surgery, I am a normal 26 year old again!!!!
  • I need to find out who in Virginia does the artfiical disc replacements or somewhere on the east coast. Like UVA, MCV, Duke, Johns Hopkins. I thinking that if you find someone who does this routinely that they can handle the insurance. I really dont mind traveling. But, I need to so something in the next 6 months to a year. I just had a ESI and the the Doc said that I dont have much space left and I night need to get something done fairly soon it is not an emergency but I need to start looking.
  • :H Well, I am knew to this website but have found that many of the discussions on this site have been very informative. Was thinking maybe I could get some more input. Here is what is happening with us.

    My husband and I just returned from an appointment with the Dr and found out, which we already knew something was wrong, his C5-6 disc is abnormal, bulging and leaking. We had tried everything that might have helped but it did not. Had the discogram and found this out. Doctor said the only other thing in this case is a fusion or an ADR. He has already had an ADR(Kinflex) at the L5-S1 level, which was a great decision in our opinion. He is only 32 years but was 30 when he had the Kineflex. He was so pleased with the ADR in his lumbar region that he wants to have a cervical ADR. Plus, he has a small engine repair business and that requires him to pretty much being moving his head from side to side or looking down to where he is working. Don't think a fusion would allow him to do this very easily.

    Now we face the task of waiting to see what the insurance company says. We have BCBS, Healthselect of Texas, through my job. When we tried to submit for his L5-S1 ADR he worked for the county and the insurance he had, BCBS, denied it. We knew he could not be off for 4-6 months with a fusion so I researced and found out about the Clinical trial involving the Kineflex. Luckily he qualified and got the ADR.

    katy55418, I see that you had the ADR in the same location as his. How did you come up with the decision to use the Prestige? I know that there is also the Prodisc. Some of the symptoms he has is terrible headaches, numbness and tingling in his arms and fingers and of course, the neck pain. Is this similar to what you had? Or anyone else for that matter. I would appreciate input from any and everyone.

    P.S. After this, we get to deal with his L4-L5 disc, which has a 7 mm bulge and causing pain. We knew this was coming when he had the ADR at L5-S1. It just was not that bad before.

  • Hey there!
    I am 24 and have Degenerative Disc Disease for like 4 years and just now I have had an Ortho Surgeon finally saying that I need an ADR. But Tricare has denied me a second time and I feel like I am at my whit's end. When I first appealed I had every piece of article and then some. But they still denied saying that it was factual and it's not a Tricare benefit. The funny thing about the 5 page letter was that it stated in a round about way that if I put down a, down payment of 1500.00 then I would be able to have it done.. Well that doesn't make sense then cause that would defeat the whole purpose of it not being a Tricare coverage, right? Anyone have any comments or insight I would so appreciate it!
    Thanks,
    Lauren
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