Hybrid surgery finally authorized~

Maria · #1 (**permalink**) 10-16-2006, 10:52 PM

Those of you who know me know that I've been hanging by a long dangling thread on WC's spiked spool and fighting for authorization for a surgery that was authorized for me back in '03 and then offer rescinded in '05 when I finally made up my mind to have the surgery! Since that time, instead of 2 level ADR, a hybrid surgery has been recommended with fusion at L5S1 and ADR at L4. And finally, nearly 2 years later~ it's been authorized!!!!!!

How did this come about?? I'm certain it had to do with taking Mark w/me as a patient advocate to the WCAB assigned 2nd surgical opinion (they had already sent me to 2 surgeons plus my own recommending the same thing).

I truly believe had I gone to that appt. alone, I may have ended up as just another statistic even tho the surgeon seemed like a really decent guy, but with Mark there, much more time was spent in review of my films and just a sort of doctor to collegue bonding type of thing going on~

Things are still in the works tho as even tho the surgery was authed to go one place and have it done, I'm trying to get back to a different place where I've been seen twice before and would prefer to have surgery done there if I'm going to have it done in the US.

So anyway, at least the dang thing was approved vs. denied!!! Major achievement with new WC legislation in place here in CA!

Thanks Mark

fortitudine · #2 (**permalink**) 10-17-2006, 01:05 AM

What great news, Maria! You have worked so incredibly hard, and done so-o-o much research. It's good to see that sometimes those things do pay off. Good luck on getting the location you want.

I hope you'll tell everyone on ADRsupport the good news story too.

sahuaro · #3 (**permalink**) 10-17-2006, 02:15 AM

Great news! It must feel unreal that things are moving and decisions need to be made so quickly after years of dealing with pain and WC. Wishing you all the best!

Sunshine · #4 (**permalink**) 10-17-2006, 03:05 AM

Maria,

Congratulations, this is fabulous news!
I do have a question: Is this approval you have received
(1) the report of the 2nd Surgical Opinion indicating his approval of the procedure
or
(2) a letter from the WC insurance company indicating approval?

I am so happy for you and I can’t wait to hear what progress you will make next.
Take care and have a great night!

Andrea

tisury · #5 (**permalink**) 10-17-2006, 03:59 AM

Congratulations Maria !!! You have fought long and hard for this. Who will be doing your surgery? Best wishes to you, and again, congratulations !!!!

dshobbies · #6 (**permalink**) 10-17-2006, 04:01 AM

Maria,

Well that's one for adr's. Mark, as always, you've come through again. Congrats to you both.

Dale

Poncho · #7 (**permalink**) 10-17-2006, 06:01 AM

One thing you have proved here Maria is that persistence pays off!

I hope to see you on the other side of this soon.

TTYL,
Poncho

Alastair · #8 (**permalink**) 10-17-2006, 09:49 AM

Good luck at Maria,
it's been many years since you've been struggling for this
best,
Alastair

chasswen · #9 (**permalink**) 10-17-2006, 10:17 AM

great news maria you have waited a long time for this.
so whens the big day?
wishing you all the best.
chuck

Eddie G · #10 (**permalink**) 10-17-2006, 01:17 PM

Great news! (for all ADR peeps!) The more approvals the merrier!
Good for you, and for everyone following you, trying to get approved.

Like I've said before, the trick is to refuse the fusion happy surgeons in your insurance co. (That includes the I.M.E.)

I only regret that NYU won't allow a patient advocate into the O.R. so I just asked that Dr. Goldstein follow up with me the next day and not someone who has no clue what happened to me in the O.R. (like my last surgery)
It really sux waking up alone with no answers.
I'll find my answers in the bottom of my morphine drip! (hiccup)

I'm not allowed to have my XM satellite radio but I can have my Minidisc. I'm making my 45 hour tape right now of funny stuff to keep me happy between drips.

Congratulations!

mrbee · #11 (**permalink**) 10-17-2006, 04:45 PM

Hi Maria,

What terrific news after the long wait you have endured! I pray that this surgery will be a success. Keep us posted as to your decision on when and where. I think of you often and pray that God will relieve you of your back pain. I do know that after the incredible wait you have gone through it seemed like it would never happen. With Mark attending your meeting with WC to share his awesome knowledge is a blessing and what a testimony that Mark is here to help those of us in such need for answers to the complex and frustrating world of spinal medicine!

Thank you Mark for your continued committment to helping those folks in such need. Maria do keep us in touch as this was the best news to hit this new forum and our community in a while! I am so glad for you what a relief but now the next step, always the next step, keep on heading forward and keep God in the equation!

God Bless you,

Willie Beeson
Mrbee
"Post five surgeries, pain free, no drugs and all the glory to God" A life restored!

letteski · #12 (**permalink**) 10-18-2006, 01:58 AM

Maria,

What great news I am so happy for you. I don't know anyone that deserves to be on the operating table more then you. I hope that on my next visit to LA we can get together and celebrate your new back.

God Bless and keep me posted

Maria · #13 (**permalink**) 10-19-2006, 04:23 AM

edited as necessary

Maria · #14 (**permalink**) 10-19-2006, 11:59 PM

The Nurse Case Manager called me today and told me that she talked w/the claims adjustor who said I can have surgery "whenever I want with whomever I want" since WCAB UR authorized the surgery!!! Whoopee!
The claims adjustor said the next step was for me to get a psychological evaluation and I said actually the next step would be for the surgeon to order it if that was deemed necessary. She agreed. Just glad that finally the fight is over and I actually have a written statement saying that the surgery has been authorized~

sahuaro · #15 (**permalink**) 10-20-2006, 03:24 AM

What a relief that WC has finally put you in control of your life!
Wishing both you and your dad all the best.

ans · #16 (**permalink**) 10-20-2006, 05:39 AM

Great news Maria. I feel like I'm 75 years old on Melrose Blvd.

Wondering if they would pay for you to see Dr. B. and in-CA follow up if you can show that this would be cost-beneficial to them (and mellower for you re: Cortoss).

Good luck, ans

Maria · #17 (**permalink**) 10-20-2006, 04:58 PM

Allan,
I have wondered about something like that as well tho am fairly certain this is just for in US authorization using FDA approved devices and so forth.

I have thought that if post op I start to have subsidence I would definately want to take my money and run off to Europe to have the Cortoss injected if Dr.B could/would do that.

When I start thinking of myself, like everyone I get this "what if" scenario going and sometimes I have to stop myself as I start getting a migraine. I think I've been over and over this all for years now and in talking things over with Mark have come to a conclusion on what to do and where that would be in my best interests at the time (hopefully).

If only WC didn't penalize a person for using a less expensive option... but it's a bull headed system with little rhyme or reason as far as I'm concerned. Oops, thankfully the bullheaded system has some mechanism for making appropriate decisions albeit slower than frozen molasses

Maria · #18 (**permalink**) 10-20-2006, 05:01 PM

Allan,
Melrose was a blast~ I found this great little boutique that had butt lifting jeans and a really incredibly soft little champagne colored leather jacket that was a *must buy* since I was in a celebratory mood~ the butt lifting jeans had to wait as they were truly as expensive as the jacket...

I felt like a youthful 75!!!!

letteski · #19 (**permalink**) 10-21-2006, 07:15 PM

Maria,

I am so excited for you I can hardly stand it. Any chance you are going to let us in on where and whom you want to have the surgery with. I know this is personal but we have hashed this over so many times. I'm with you on whatever decision you make as long as you don't back out this time and get yourself on that operating table sooner then too much latter.

God Bless my friend

imkathy · #20 (**permalink**) 10-21-2006, 11:43 PM

Congratulations on the successful battle! I am now up against the insurance beast. I have gone through the facet block, which was negative; and the discogram which told the doctor that ideally I should go for this hybrid, but doe to insurance (the lack of) and my financial situation, I am headed for an adr L5/S1. I am not sure if we can name names, but I am at the max of my out-of-pocket with my insurance and they are not very user friendly when it comes to the hypothetical what if.. discussions. At best I might get some coverage for the hospital, I am not sure if the consultations were even covered. It is all too new. I went to the surgeon Oct 12th then October 19th and now I am going for surgery November 6th. Any advice onthe ultimate insurance battle? My back is purely ddd, no accident really to blame. (I just got lucky)

Thanks!
Kath

Spotty14 · #21 (**permalink**) 10-22-2006, 01:14 AM

Congratulations Maria - I'm so glad to hear the good news!