Dr. Regan and ADR Explant Surgery

[runner]

Jim,

Sorry your surgery was postponed. I have had my surgery postponed before, no fun. I haven't been on here in a while, but decided to pop on tonight.
I haven't had an explant, but I do have 2 ADRs. They do appear to be working correctly, but something is wrong at L5/S1 in my case. If you need to fall asleep, you can read my thread if you want. I am kidding, but I wanted to lend my support and hope you get what you desire soon. My last surgery, it was postponed because I had a bacterial infection. Luckily, i did not have an insurance problem with that one, but I did before. So good luck.

runner

[Maria]

Jim,
Sorry this happened to you especially when you are told to stop your Nsaids or meds two weeks prior to surgery and made arrangements re work for time off and your wife was well plus arrangements for care.

In the "olden" days or back when I was having surgery particularly I guess because it was WC authorizing, scheduling wasn't done until the authorization had been obtained and then that was good only for a certain amount of time (which I cannot recall now). To me that seems like the safest bet re scheduling especially in terms of all that the patient has to go through with personal arrangements.

I do hope you will get the authorization (every aspect of it that is) and surgery will be scheduled and performed in a timely manner. Sorry you had to go thru this emotional upheaval and any upheaval of your schedule and your family's.

Do take care~ Maria

[Jim M2]

Okay, here's the skinny. Blue Cross Blue Shield is waiting on more documentation from Dr. Regan's office before giving pre-authorization. They only pre-authorized removal of the ADR. Generally they don't authorize fusion if the radiologist report doesn't mention instability at that level. Here are some of the other billing codes submitted by Dr. Regan.

22865 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar
20936 Autograft for spine surgery
22612 Lumbar spine fusion
21842 ?
20930 graft for spine surgery

I'm really bummed out. Who knows when they will get around to dealing with BCBS. I'm sure Dr. Regan has plenty of patients that fall in the category of low hanging fruit.

Barbara - that's a great idea. I'll ask about the pre-surgical physical tomorrow.

runner - Thanks for the thoughts. I read up onparts of your thread, it's a long one!

Maria - I remember some of your issues with pre-authorization. I've been off the NSAIDS for almost 3 weeks now. I'll be ready to go.

[Maria]

Jim,
I actually had a 2 level ADR authorized two times .. first with a surgeon at UCSF and he had shoulder surgery and trial was stopped before my surgery was happening. 2nd time Surgeon in Dr. D's office didn't send back information to WC in timely manner (he had 3 months to submit information) so that authorization was off the table. Took 2 years to get a surgery authorized again and by then I wasn't a candidate for 2 level ADR.. rather ADR and fusion. At that point I was going to go back to the same surgical office but not with same surgeon. It may not have been the surgeon's fault but that didn't matter to me at the time.

Sometimes it's the Dr.'s office and sometimes the insurance company.. sometimes it's the patient I don't think it will be the latter in your case. Hope you don't have to wait too long! Maria