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Want to have a disc replacement not a fussion

AnonymousUserAAnonymousUser Posts: 49,321
edited 06/11/2012 - 8:24 AM in Back Surgery and Neck Surgery
Hello everyone. I am 39 years old and have had a fusion at the C5-C6 level. My surgery was done about 2 years ago. The surgery went well and I have fussed properly, but some of my arm and neck pain remained on the left side, and I have been in treatment and on meds ever since. By the way, the recovery from a fussion, at least in my case was terrible. I have been suffering from neck, back, leg and arm pain for almost 12 years. Prior to my surgery I tried every alternative method possible. Nothing worked for very long and I was never pain free. My disc finaly herniated and had no other choice but to have the surgery done. My doctor talked with me about disc replacement, but informed me that it was not FDA approved for the cervical spine yet and that it was about 2 years away. Obviously not covered by my BlueCross/BlueShield Insurance. I couldn't afford to pay for the surgery out of pocket, so I had the fussion done, which they paid for. Along with the herniated C5, the MRI showed that the C4 and C7 discs were bulging. We discussed the possibility of having a Prodisc replacement, if one or both of them herniated at a later time, hopefully it would be FDA approved by then. Well, the C7 has herniated and it is the most painfull thing I have ever experienced. I have had nerve blocks, PT, taking meds and nothing works. My right arm and shoulder hurt so bad I am unable to function. I just had a visit with my surgeon and he has informed me that the herniation is very bad and surgery is the only option. I asked if the FDA approved the disc replacement and he said,"yes". I thought for a second I had hope, until I saw him looking at my chart. I asked what was wrong? He told me that the wonderfull people at BlueCross/BlueShield stil concider disc replacement as experimental/exploratory and due not cover the surgery. Also, many hospitals and outpatient/surgical centers, here in California, have dropped BC/BS. I will have to pay for it myself, which I can't afford, especially in this economy. I am so dissapointed and disgusted with them. It seems like I always have to battle with them to get coverage. I don't want another fussion. If anyone has appealed or challenged them regarding a similar situation and could offer some advise I would greatly appreciate it. I am desperate. I need to do something soon, because the pain is going to ruin my life. I am running out of energy to fight.




  • Sorry to hear about your problems.
    I joined Spine-Health in 2007, so I am an old new person. I had disc replacement (ProDisc, L4/5) in March. I am now 7 months post-op and I don't regret my decision to have ADR over fusion.
    I have appealed BC and protested against health insurance companies. I marched across the San Francisco Golden Gate Bridge two weeks ago, protesting for single payer health care.
    In fighting my lovely insurance, BC, I have become sort of an activist.

    I believe what BC is doing in denying ADR surgery is criminal and should be illegal. I know some things about appealing their decisions. PM me.

  • Mike,

    I just had an ADR done 4 weeks ago and my insurance company (BCBS) covered the bill as long as it was inpatient. I stayed over night and as far as they were concerned that was enough time. Good Luck.

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  • If disk replacement is the best option for you, then I pray you can find a way to pay for it. Please PM me when you have a chance. I may have some suggestions for you, especially if the medical bills are way too much to pay for yourself.

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