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Insurance covering Total Disk Replacement ?

KaitiedidKKaitiedid Posts: 20
edited 06/11/2012 - 8:45 AM in Health Insurance Issues
I'm in need of surgery on L4-5 and L5-S1.I was told that none of the health insurance companies will cover a two level disk replacement.And the list of insurance companies who cover a one level TDR is small.Lucky I do have insurance with one of the ones who does cover one level TDR.My question is has anyone found coverage thru insurance for a two level disk replacement? I really would like to avoid fusion even though its one level because I have allready had failed fusion at C5-6 and had to indure a Revsion Surgery it was horrible. :''( I would appreciate any information on this subject.Thank You >:D<


  • You might want to check out the insurance forum here as well. I know there are a few floating around whom have had more than one level ADR's. I might also mention there are some failed ADR's on the boards as well. You might want to send a pm to alexhurting as he has had a major issue with a one level ADR, just to get both sides of the story.
  • Be sure and carefully research the success rate of the TDR before making that decision. It might be better now, but recently it was even lower that spinal fusion, and they were not lasting long. That might be why so few insurance companies are covering it.
  • Thank you for the input.I have been researching like crazy I spend the better half of my day doing so.So far from what I gather Some of the major companies are covering it and the others are not as of yet because here in the states it's still a relatively newer surgery.However in Europe they have been doing it for a while now with alot of success.
    But as we all know there is no guarantee with any surgery of any type.Problems can happen I know this 1st hand. I had a fusion surgery 3yrs. ago that failed had 3 screws that pulled out,damaging connective tissue all over the area,fluid build up within the area where it should have fused.In other words a mess !!! :''( At this point I'm doing the research I have not made any final decision just trying to find out if anyone has had there insurance cover a two level replacement.Thanks. :)
  • SpineAZSpineAZ WiscPosts: 1,084
    It's also important to find out if you are a candidate for ADR at one or two levels. My surgeon told me that I was not a candidate based on my history and other problems (ligament and tendons very lax).

    First, the doctor has to decide you are viable candidate and then you seek insurance approval.

    Also keep in mind that sometimes limitations are insurance company based and some are policy based. An employer purchasing a medical policy for employees may opt out of some experimental/not yet proven treatments even if the insurance company has it as an option.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Thanks SpineAZ for the input. I have already spoke with the surgeon I am a candidate for ADR on both levels but he said because the insurance companies are only covering one level at this time. And only a handful are covering ADR as well. I see so may people saying they had had mulitiple ADRs I was curious how they we're paying for it.I thought maybe he was wrong possibly on them only covering one level.So I thought this would be the place to get some feedback on the issue. So far not to much. I also pay for our Insurance personally not thru an employer. So that's a plus .Plus my healyh insurance is one of the few that do cover it ADR. I just haven't scheduled it yet I want to do my homework 1st it's a big decision in all aspects.Thanks. :/
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