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Upcoming surgery Maybe not need help

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Back Surgery and Neck Surgery
So I scheduled my surgery for March 17, 2009 and today i get a call from the hospital saying that since the ADR isn't covered by surgery I have to put a deposit of $18,000.00 down or I can't have surgery.. How is this fair I am 38 years old and at this rate living in continues pain and my numb leg I will be crippled... The doctor wants to do a L/5 S1 fusion and a L4-5 ADR... I already had to borrow money to pay my surgeon.. How can they put a price tag on my life.. Please help..

Feb. 2008, April 2008, July 2008, and October 2008 had laminectomy L/5 S/1 all the dates above.. Now I have a different surgeon..


  • I'm really sorry about this. I have medicaid and I have been told in so many words that people with medicaid are not worth anything. I have to accept the fact that I'm stuck and can't ever get out of this pain cycle I've been in for most of my life. I am struggling with this idea. I have been in pain for over 20 years and although medicaid WILL pay for surgery they will not pay for many pain medicines. Does that make any sense? I have every reason not to this one. ALL of the surgeons I have met with acted so rude and talked to me like I was disposable. No compassion, no understanding,its all about $$$$$.

    It really sucks that a price can be put on our lives. It is exactly what it is though. I don't know what to tell you because I have not had positive experiences but I really hope you get something done. What kind of insurance do you have?

    I wonder though...who the H### can come up with that kind of money??? Give me a break!
  • I meant to say I have every reason not to trust this one...
  • What insurance do you have, medicaid? Sadly medicaid is about the worse thing you can be on, and saddest part is it's the most disabled that have to go on it.

    Medicaid never pays enough to cover the cost of anything, from xrays, surgeries, general care even. They barely cover the cost of the materials much less labor.

    Is there any other surgeries you could have that would give similar results if you absolutely can not come up with $18,000?

    Do you have any family, friends that could either loan it to you or cosign for a loan? Anything you can take a loan out against?

    Living in back pain is horrible I know, If I would not had the surgery I had I would be truely disabled right now.

    Have you talked to the hospital and explained your situation fully? Will they not do a payment plan of any sort?

    I had to pay my surgeon $1200 beforehand, they insisted but if I had not had it I couldof talked to the surgeon and Im sure we couldof arranged something.

    Please give more details must be a solution somewhere forya.

  • Fusion is considered elective, not life-saving. No, they don't care. Perhaps they will allow a payment plan? Or something?
    You might consider it a mixed blessing. My fusion surgery has so far left me WORSE, and I'm thinking I was better off not having it.
  • I have BCBS and they will cover the Fusion but not the artifical disc.. I just don' know what to do anymore 4 failed Laminectomy's last year and in more pain than ever and live off pain pills to me that is not living life
  • I think that is why my doctor insists on doing 1 level fusion and artifical disc he said the success rate is way better.. No payment plan they said $18,000.00 up front end of story I just want to be out of pain I have been on pain pills for a year now and they are getting to the point of just taking the edge off the pain is still there 24/7 365
  • also this is just the hospital I already borrowed $5000.00 to pay my surgeon. I just can't believe this those paper pushers don't care if they had to live in pain like this they would push it right through with a major discount LOL
  • bcbs has became a major issue for all health care providers. They are paying less then medicaid/medicare in a lot of situations.

    My hospital just dropped them as their insurer and went private, and their hoping other major corporations/businesses follow suit as BCBS is a huge monolopy in MANY areas of the US.

    On another note ADR is def elective at best, and not covered by a lot of insurance plans as of this time.

    Also realize back surgery is an iffy topic for all.

    I had a PLIF L2-L5 (Fusion) with disectomy and lamenectomy L4-L5 as well, had a spacer placed titanium I believe.

    I have no pre surgery pains, and no pain at all as of 1 month post op. Doing therapy and doing great.

    It works for some and doesnt for others. Its a chance. take it or leave it, this is how I looked at it as I basically went to my spine surgeon and was told surgery was my fix, said ok 2 weeks later had the surgery.

    I thought to myself, can I live in my current condition? And I knew instantly no.
  • I can relate somewhat, I have BlueSheildCA and they took 3 months to finally deny my request for hybrid fusion/ADR S1-L4 surgery, but as far as I know they will cover the two level fusion. I wish u the best of luck, it seems that you are in the same amount of pain that I am. Im on norco and it really doesn't take the pain away at all. I know how desperate the situation can seem when all you want is to be able to live a productive life and u can't get what you need. I wish you the best of luck.
  • So have you had the double fusion?? My insurance will pay for that but they won't pay for an ADR.. and my doctor only wants to do a one level fusion with and ADR above it.. He said that if I was older he might consider but being young and so much more life ahead he wont but I am thinking if I can be out of pain and not in the hole 78,000.00 it might be worth it :) please let me know if you have had this done and the out come.. Thank you
  • what is the difference between a spacer and an ADR??
  • There are many people who have had at least a two level fusion that are young. It has only been recently that we even had the artificial disc approved by the FDA. Scoliosis patients have routinely had multi-level fusions and many get along well.

    You might want to get an opinion from another spinal specialist if you cannot find a way to get the surgery covered. It's not like the one surgery is your only option. Many people do very well with a two level fusion.

    Hope you can get this problem resolved to your satisfaction.
  • BCBS still considers ADR's to be investigational/experimental therefore, they will not cover it. They will however cover a fusion. This doesn't make sense to me cuz even though a fusion can fix your problem, it's only temporary as it can cause other discs above or below to degenerate or bulge due to the added stress it takes over from the fused disc.

    I've had medicaid since October cuz I lost my job and insurance cuz I've been out on disability for too long. COBRA is way to expensive to pay so I had to give up my insurance for Medicaid. Since I've been on medicaid, 2 of my docs who have already discussed other options and treatments now all of sudden can no longer do anything for me. It makes me wonder if it's because they don't get reiumbursed as much from medicaid as they do BCBS. My doc wrote me a script for oxycontin and medicaid wouldn't approve so I'm now on mscontin which doesn't seem to be working that good. I wonder if the oxycontin would've worked better. I'm not sure if this is something I have to appeal or not.
  • I am 25 and had a 3 level fusion, with a spacer placed at L4-L5, lamenetectomy, etc.

    Doing great 1 month today post op if that helps.

    If you want any more info PM me.
  • That is excellent information thank you very much.. I just know that having a fusion puts alot of pressure on other disc and then I will have to have surgery pretty much the rest of my life :( I will keep everyone posted crossing my fingers for sure
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