My 3 mo X ray - Discs tilted all over the place

[Kathy]

Steve,
My surgeon in Florida, the co-inventor of the Active L disc, does revisions. I made sure of this before I had surgery, so I would be able to get it out if need be. Maybe you could fly out and consult with him. He was a very nice humble man and highly reccommended by fellow spineys (Justin and Mark both had good things to say about him). I would also make for absolutely certain that the top disc is fine. I completely agree that it is the prudent thing to do to get more than one opinion, regardless of who you have surgery with (I got 3 opinions before my first surgery, which is way easier than a revision). I also think that you should push for a more discounted rate. Also, I know on the billing I received for the surgery, it showed a seperate insurance billing for removal of the old disc and another for placing the ADR; so maybe you could get insurance to pay for the fusion part and just have to foot the bill for the removal of the old disc. Too bad Dr. B doesn't have the revision policy of Stenum, seeing as how the revision rate is low, doesn't seem like it would cost them much (unless they had tons of revisions). Seems like a great policy, too bad US dr's don't offer it (guess you need tons of confidence in your skill to offer a policy like that).
Best of luck,
Kathy

[sahuaro]

Steve:
I am chiming in late here because I've been trying to avoid the full impact of the implications of what you are dealing with. I am so sorry this has happened and that you are now in pain. As a cervical ADR recipient--with osteopenia--the prospect of subsidence scares me to death and I am impressed with your great attitude at this point!

Perhaps Mark can help you with getting second opinions in the U.S.? And I would seriously consider consulting with Dr. Regan, who did my surgery.

Also, since the pain seems to come with lying down, would a cervical pillow (e.g., Tempurpedic) help? Would sleeping in (ugh!) your soft collar, assuming you still have it, help?

I wish you all the best.

[steve55]

Yea, I guess I am bummed that I didnt get a little better discounted price for what clearly shows 2 tilting discs. No doubt the bottom plate of the top disc is sinking to the right, its quite obvious, yet oddly enough, they didnt even mention that one. Ill see what Peloza says about that top disc next friday. Again, not necessarily Dr B's fault and I still think he is a great surgeon and I appreciate he spent 6.50 hours on my surgery and he took the time to really make sure all my nerves were freed up. But gosh, I guess ya all are right, you'd think I would have gotten a little better break on the price given the circumstances. Oh well, I guess not.

Anyways, I spoke to the Humana rep today and she seems to believe that as long as we prove medical necessity, she thinks they will cover both the removal and the fusion. She didnt seem to think that the fact I had ADR's (a non approved procedure) would affect their decision to cover both the removal and fusion if its medically necessary. If she is right, then I have a good chance at either going out of network with a$6K deductible (which she said would apply if I went to Br B in germany) or staying in network with only a $2,000 deductible.

My out of network options would be:
Dr B -I still very much trust him , but ughh, I really dont want to deal with travel again. Too much hassle, connecting flights, crappy food, no freakin TV to watch (Ill go nuts watching CNN Europe or whatever that one channel is for 2-3 weeks), lots of extra expenses etc. Only positive is DR B's heavy experience with revision surgeries, I presume??. Will still consider him for sure.

Dr Peloza -My previous doc who treated me all this time before I went to Dr B and he is in the same class of surgeons as Delmarter, Regan, Biton etc. He is local. BUT, dont know how many revisions he has done though.

Dr Regan - Experienced revision surgeon right?

Dr Delmarter - NOt sure of his revision experience, anyone want to tell me?


My one in network option would be Dr Biton in NY (only $2K deductible) -not sure of his revision experience either. However, one person here did say Dr Biton seems to have done many ADR revisions. So, at this time Im leaning towards going with him if he has the experience Im looking for and if I can get Humana pre approval. It would be nice to stay local with Dr Peloza, and I would have a local follow up, but the extra $4,000 deductible difference is alot. I get free travel on Delta since my dad is a retired delta pilot so the cost of flying to see any of these surgeons for follow ups would be limited.

If it turns out that these US docs dont have extensive ADR revison experience, Ill probably just go back to Dr B to be safe. Experience is most important with these things.

[Kathy]

Steve, I have heard lots of great things regarding revisions, with Dr Bitan and Dr Regan. I think if I were you, I would stay in the US. Seeing as how it is not a multi level ADR being done, US surgeons have tons of fusion experience (it's really just the revision that you need to check for). You can watch Dr. Bitan doing a Charite implantation on the Charite website (google it and there is a link). Watching him do the surgery and online research is what made me decide to have ADR. I don't think I would spend the time, money and travel to go to Germany to get a fusion, seeing as how they are so commonplace here in the US and since it is cervical, not near the risk of a lumbar revision.

[phylly]

Steve,
Just an FWI, different doctors consider revision differently. Some do removal and others just fuse over the disc. If you have severe subsidence you may need it removed and not all doctors want to undertake that surgery. I was pretty lucky to have someone take mine out anteriorly. It is a BIG dangerous surgery. I wish you the best.
Phylly

[steve55]

Ill see what Dr peloza thinks. I think the Cervical isnt nearly as dangerous as the lumbar, and its pretty easily accessible.

In the meantime, Mark got back with me. He says Dr B is going to call Dr Peloza ahead of time and update him before I meet with him. So, thats nice he is is trying to do whatever he can to help out. Regarding the price issue, Mark made a good point. How many doctors in the USA or anywhere for that matter offer to do FREE revisions if it doesnt work out? None! Just Stenum only. So, that is something to consider before passing judgement on the price quote situation.

Ive spoken to another Humana rep and she also re affirmed that if my disc is tilting/slipping and there is clear medical necessity to fix it, they will cover it. They wont care that the artificial disc was something they dont cover in the first place. This means I can go out of network with only a $6,000 deductible, and then I pay 30% of their reasonable and alllowable rate. That 30% is likely to kill me if done here in the US. Who knows how high it may go to. However, with Dr B, their prices are so cheap compared to here, Im only going to pay the $6,000 + 30% ($3,600) of the 12K remaining balance, which totals $9,600.

Surprisingly enough, Mark did say that Dr Regan will likely do the surgery at some minimal agreed upon total cost. I think that his getting my $6K deductible plus 70% of the Humana allowables, (and letting me off the hook for the other 30%) he should be good to go. This is the feeling I got from my talk with Mark, if I understood him right.

So, in a nutshell, if Dr Peloza isnt willing to do this at the same rate as Dr B & Dr Regan, then Ill have to decide between the other two. Im inclined to stay in the US though.

Either way, I agree, I have to get this taken care of. My shoulder pain is now EXCRUTIATING! But the pain pills do a really good job of knowcking it out.

[steve55]

Dr Biton called me back already, as I had emailed him with my I phone picture of my x rays around noon. He's a super nice guy as katie said. He said he would work with me on the price so that it works out close to what Id end up paying by going back with Dr B. He said that he felt confident that he could probably waive my 30% in my plan. It seems to me some of these docs are happy even with only the Insurance co's 70% payment. He said he would not hold me to overages or anything the insurance co wouldnt pay for.

He did say that the top disc looks like it has issues too, and didnt think its only because of the bottom disc's effect on it. But he also said that I may not need to do anything about the top one as it's not that bad and as long as its not causing pain, I might be best to just leave the top one alone. Of course its all preliminary and he surely needs the originals and more work up before being conclusive with anything. He did put my mind at ease and said he didnt think anything serious could happen in the meantime, and said he felt the revision was a easy fix due to it being cervical and for me not to stress out about it. So, thats REALLY reassuring.

[dshobbies]

Steve,

Can't comment on Dr. P but I think you have 3 good choices with the 2 Dr. Bs and Dr. R. I think I would trust any of them and since the cost is not too much of a factor anymore, you can stay in the US if you prefer. Though the airfare would be less, the hotels in New York and Los Angeles are a lot more expensive than those in Bogan/Straubing but I guarantee, the TV is better.

If you come to LA, I'll be happy to take you to lunch.

Dale