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Can't decide

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:20 AM in Back Surgery and Neck Surgery
Hello all. I'm a 39 year old patient at the Texas Back Institute, and I have 2-level herniations from L4 to S1. My insurance has agreed to pay for a single Prodisc replacement, but won't pay for a 2-level or a fusion hybrid. The cost to add the 2nd disc is $17.5k (7.5k for doctors, 10k for the disc). That's a pretty steep amount for me right now. Do I:
  • Beg, borrow and steal to come up with the money and have the 2-level ADR?
  • Have a 1-level ADR since I can afford that, and have the 2nd done in a future operation?
  • Wait until a clinical study is done for 2-level ADR and try to get in? (this is looking like it will be a year or 2 out, minimum)
  • Or pay for a hybrid? (don't know what the OOP would be, but I'm not too excited about the fusion aspects)
Important note: My insurance carrier might change next year due to some things happening at work, so I don't know if I'll still have a "disk friendly" carrier in the future.

Lastly, I'm curious to know what other's experiences are with trying to negotiate prices. Moreso I'm interested in negotiating a lower price on the disk itself, as I know there is markup and sales rep commissions involved potentially, so should be some wiggle room, but so far contacting Synthes lead me nowhere, and in my case my doctor isn't the interface with the sales rep, it's the hospital instead, but haven't yet tried to negotiate with them, wanted to hear your advice first. Thanks!


  • First of all, welcome to Spine Health. Hopefully you will find the support you are looking for, or at least you'll find some sympathetic listeners.

    As far as your question, wow, this is quite a dilemma. In all honesty I have not been in the same situation. But hang in there, maybe somebody with more understanding of the insurance business will respond.

    I truly wish that you'd find a solution.

    Best to you,

  • Before my recent laminectomy, NS mentioned a fusion at L6-S1 (I have 6 lumbars)along with ADR at the L5-6 level where disc herniated this time. I had already had a laminectomy at L6-S1 so I suppose fusion was the only option at that site. As the recovery time, plus having to drive out of state to have this done, I decided on the conservative approach of another laminectomy. As far as the insurance aspect of the hybrid surgery, I don't know, we didn't get that far into that discussion.
    If it were me, I think the most important factor into determining what to do would be the level of pain I was in, and what my NS recommended to get my pain to a managable level.
    Good luck, Tergo, in what ever you decide to do.
  • wow, 6 lumbars! That's pretty cool, but I suppose causes more problems. Regarding my pain level, despite a 6 mm herniation at L4-L5, and similar at L5-S1 (doctors have never told me the exact size), I don't take any painkillers on a regular basis. Thing is, I can't do anything. If I stand too long, or sit too long, or work in the yard or try to carry something heavy, then slowly the pain increases. I've had bouts of spasms and "screaming out in pain" episodes which required hydrocodone, but they only occur when I push myself too far. So, I'm not really interested in doing the surgery to get away from pain, I'm mostly interested in getting back to doing the physical things that I enjoy doing. If left alone, my situation is only going to get worse, might as well get surgery while the rest of my body is still relatively healthy is my thought. I've had these herniations for around 10 years now, and have done chiro, massage, muscle relaxers, McKinzie PT, stretching, decompression using a machine and decompression using inversion. All of those things did help to various degrees and I do feel that some of them are why I'm not having to take pain pills, but I'm ready for the next step, you know what I mean?
  • I too was denied by insurance for a 2 level ADR. The Texas Back Institute helped me fight with insurance back in 2006 and we were denied. I finally had all the pain I wanted after 7 yrs and decided on the 2 level fusion which I wish I had done sooner. I'm now 5 1/2 months post op and have my life back. No pain pills in 2 months which I thought I would never get away from. Watching what I do at all times to prevent any future back problems. It was a hard decision but you will know when it is time for yourself. Good Luck!

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