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Upcoming fusion L5-S1 and ? Artificial disc replacement L3-4/My insurance has denied Artificial disc

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:33 AM in New Member Introductions
Hello out there!!

Looking fo some advice,support.
I am 39 yr old female Mom of 2 teens and married x 18 yrs.
Occupation: Reg. Nurse currently on short term disability.
DX: DDD Lumbar; Herniation L3-4, L4-5 L5-S1 grade 5 tears
Mri,bone scan Discogram + at L3-4 and L5-S1 levels 6/09
Pain and one herniation started back in 1999 and since 2 further herniations.

Have tried conservative methods, Chiropractics,PT, Pain meds, tyl #3, percocet,Dilaudid,Flexeril,Epidural steroid inj x 5-6 over last 2 yrs.(last ones in 3/09 and 5/09)
Pain greatly intensified 1/09 especially with sitting. Low back pain L hip pain and bilat leg pain L>R. Great toes bilaterally get bad spasms,esp. with lying down.

Saw Neurosurgeon in 6/09 who ordered the bone scan and Discogram,spine xrays.
did more PT x 5 wks.
Scheduled for anterior lumbar discectomy L3-4 and L5-S1 with total disc arthroplasty Prodisc-L at L3-4 and fusion and L5-S1 with syn fix,BMP,bone graft in August '09.

The Neurosurgeon office called me Fri 7/17 stating my insurance company has denied the Art Disc stating "the procedure is experimental"

I have researched it a little on line and found that the FDA in the U.S approved Prodisc-L in Aug of 2006.

I am looking for advice on how to fight this without delaying my surgery in August.
I have called my insurance comp and initiated a "expedited appeal" and should hear back from an "appeals coordinator" in 72 hrs.

I have also asked my Neurosurgeons office MD or PA to do a "peer to peer " review with a MD at my insurance company.

I have already had Pre-ops done and have donated my first uniot of blood.
I have appt with Vascular Surgeon tomorrow and give my @nd unit of blood this Friday.

Any help will be much appreciated!



  • I fought with insurance for 1 1/2 years and finally had to give in and have a fusion. I am doing well. Insurance companies usually take their time on decisions. I hope the best for you.
  • hi and welcome to the forum! :H we are here to offer you support and answer what questions we can. check out the "Insurance" forum for some input on your problems.. :? good luck as you go for your procedure.. keep us informed! :D Jenny :)
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