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[dshobbies]

Hi Kathy,

Welcome to the forum. Glad you found us but your circumstances, especially with two small children must make your life very difficult. What did the MRIs tell you? Is L4/5 your only pain generator? You've been dealing with this for 3 years and though the worlds of insurances wrangling turn too slow, I would have thought it would be settled by now.

If you were hit by a semi, I would expect them to take care of the medical bills and not your own ins co., who by the way, will more than likely turn down your request for an ADR, but keep pushing. I have heard good things about TBI and even if your insurance should come through, you might want to consider staying with them. The doctor's skill and experience has a lot to do with your ultimate outcome.

Is there any timeline yet for the clinical trials? Hang in there, I'm assuming help is on the way. Glad your children checked out OK. There's your blessing!

Good luck, Dale

[melodyl]

Hi Kathy,

Welcome to this group. Although I don't post much, I read what others have written and have found the information to be very useful. I am currently home recovering from a 3 level Prodisc C (C4-5, 5-6, 6-7). My surgery for ADR was initially denied by my insurance company as "experimental". I appealed and it was again denied....this was after FDA approval of single level Prodisc C procedures. I almost gave up on insurance and started making plans to spend our retiement money to go to Germany to have the surgery done there. However, I was extremely lucky to have a dr. that was willing to fight for me and my right to have the surgery that I needed. He wrote letters appealing the insurance companies decision. I also got my H.R. department involved, who got the broker for the insurance company involved. Eventually, we came to some agreements that at least allowed me to have the surgery done. The cost of two of the implants has not yet been resolved, but I will keep fighting to get them paid for! The insurance company did agree to pay for the surgeon, hospital costs and one implant. I'll try to keep this group undated as to how it all ends up. Basically, my message to you is don't give up! You have rights. I made dozens, maybe hundreds of phone calls to my State Insuance Commissioner and others who offered suggestions or information. Keep this group updated on your progress and how you are feeling! Best wishes, Melody

[Kathy]

Originally Posted by dshobbies

Hi Kathy,

Welcome to the forum. Glad you found us but your circumstances, especially with two small children must make your life very difficult. What did the MRIs tell you? Is L4/5 your only pain generator? You've been dealing with this for 3 years and though the worlds of insurances wrangling turn too slow, I would have thought it would be settled by now.

If you were hit by a semi, I would expect them to take care of the medical bills and not your own ins co., who by the way, will more than likely turn down your request for an ADR, but keep pushing. I have heard good things about TBI and even if your insurance should come through, you might want to consider staying with them. The doctor's skill and experience has a lot to do with your ultimate outcome.

Is there any timeline yet for the clinical trials? Hang in there, I'm assuming help is on the way. Glad your children checked out OK. There's your blessing!

Good luck, Dale

The first MRI showed a tear at L4/5. I then had Idet to try to 'seal' the tear. The next MRI, about a year later, showed DDD, a tear, and a bulge at L4/5. However, my dr. at the time, did not tell me this and I did not see the MRI report. They acted like they just didn't know why I was hurting. It wasn't until I left that practice to go to TBI that I got my medical records and saw that. My most recent MRI shows a herniation, that it is torn through the annulus (Dr. Zigler said that it is torn to much to ever heal), DDD and mild facet arthritis at L4/5. I don't think any other levels showed anything, I will have to look at the report to see for sure. The discogram before the Idet was 10/10 at L4/5, with no other discs having pain. The discogram I just had, was also 10/10 at L4/5, with no other discs having pain.

As far as the other insurance paying for me... They have been nothing but a pain in my a$$. I hired an attorney, because they didn't even want to pay my medical bills. I just settled with them a couple of months ago; but didn't end up with much, after everyone else got their share. Also, I was hit head on in a 35 mph crash in July of 2006. Because of the way the Texas laws are written, the 18 wheeler company is only responsible for my care from Jan 06 to July 06 (when the other wreck occured), this is called an intervening action. The second wreck I was in, the person does not have high limits, I believe they have 25K available for the other persons care. So, we are having to use my un-insured/underinsured insurance on my vehicle, to try and cover my care. But, the problem is, that I have to pay everything out of pocket; but I can use my health insurance. Then, when I decide to settle (which means that anything beyond that point will not be covered), then I get paid for all my care. The money then gets taken, the atty gets 40%, my health insurance gets paid everything they paid out of pocket, then I get what's left. It sucks.

I will be having Dr. Zigler do my surgery, regardless if I have the Pro-Disc or if I am the clinical trial. I really like him and he comes highly referred. The clinical trial has been pushed back several times, due to paperwork. I think it will start by Feb or March. I won't be having surgery until March. I am going on a cruise with my family in Feb. and don't want to be in recovery then.

Kathy

[mmglobal]

Kathy, I hope you don't mind, I moved your thread to the main forum.

It sounds like you've done pretty much everything possible to avoid the ADR surgery. It's so outrageous that when we are injured AND have insurance, we still have to fight a system that seems to have everything stacked against us. The new guy gets to point at pre-existing conditions and say, "not me", the entity that was on the hook for the prior problem gets taken of the hook by the 'intervening event'.

Keep up the good fight. All the best,

Mark