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Aetna denial for two level disc replacement and will only approve fusion



  • nutcase007nnutcase007 United StatesPosts: 953
    Joes - Did your surgeon approve the use of Advil?  Maybe they allow Advil with ADRs, but I would be very surprised.  If I understand the design of ADRs correctly, the bone still needs to fuse to the plates of the ADR.  With all of my ACDFs, I was not allowed the use of any NSAIDs (Advil is an NSAID) for at least six months. 
    Please make sure that Advil is approved.
  • Thanks. Yes I had a two level ADR Mobi c c5c6 c6c7. I  am taking it easy though it’s very difficult since I’m person that can’t sit still. I trying a little reprogramming to prevent going to far.  I have two bright colored wristband for each hand. One has printing “ Don’t do it” and the other “ think about first”;. Sounds corny’s working for me . I would jump right into something to help someone without thinking in a heartbeat. I have a shop garage full of tools and a few hot rods that keeps on persuading me to play . I’m holding off . 

    Physically I feel great. I’m taking Norco every 6-8 hours along with Advil. Sooner off the pain meds the better. I’ll ice my neck if it gets a bit sore. Sleeping like a baby at night which sure beat the 2-4 hours of sleep I was getting pre-op. I do have a foam wedge to raise my back and have a pillow under my knees. Still eating soft foods . My throat still is sore and still feels like I have a lump in it when I swallow. 

    The initial  insurance denial was unbelievable. The radiologist that read the mri stated mid stenosis and degeneration of the c4c5 disc which was above the two herniated disc that were my problem. They felt a fusion was the best solution. My surgeon studied as an engineer prior to getting into  orthopedic medicine. I have an engineering background also. So In the design world if you had a disc above  or below that was what they called out mild generation, why would you induce more torsion on those disc and cause them to fail.

    A fusion does exactly that, whereas the ADR does not. Maybe some of these doctors need  a high school physic class. . Really what I feel is that physician reviewing my case  did not have experience in the orthopedic spine field should not be making decisions based a scripted policy. I was very close to pay for this procedure and follow up legally . I’m thankful I did not have to go that route. It would of been stressful and time consuming. 

    I really did not get a PT instructions post op. The doctor said I could wear the neck brace if I feel the need to ie passenger in my wife’s bouncy Jeep. The therapist did emphasize on no jarring movement, don’t fall, walk on flat even surfaces, use hand rail going up and down stairs, no running or jumping and do not lift anything over 5 lbs. 

    Follow up with my doctor is this coming Wednesday, his plan for me might change. I know for sure recouping is 6-8 weeks prior to performing lift duty tasks. 

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  • Looking at my discharge paperwork it does state ibuprofen (Advil) every 4 hours as needed for mild pain.

  • nutcase007nnutcase007 United StatesPosts: 953

    Wow, I'm very surprised they have you taking ibuprofen.  With every ACDF that I had, I was told by the surgeon that ibuprofen was a no no.  Even when I had broken bones, I was instructed no ibuprofen.  Maybe it is the ADR design that does not matter.  This is the first time that I remember of hearing that a post-op spine patient being allowed to take ibuprofen. 

    I wish that I could have had ADRs implanted, but I was not a candidate, because the facets in my neck are all messed up from severe whiplash, so I'm now fused from C2 to C7 and hoping that my C7/T1 does not deteriorate too much.  The whiplash also left significant damage at that level.  

  • Update. Yes A1btr it’s was a multi level ADR with the Mobi-c. So far everything is going great. Still no lifting over 5 lbs. No running, jumping etc. I am able to drive short trips . The lower neck does stiffen up a bit occasionally. The doctors forbids me to take any anti inflammatory meds. They want inflammation to aid it the bone growth to the hardware. I see the doctor on the 8th . I’m hoping I get the ok to go  back to work. The only thing I’m concerned with is my commute downtown on the train. It’s not the most neck friendly ride with the rocking and hard stops. Overall so far I’m extremely happy with the results and glad I fought the insurance company.

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  • I'm so happy the insurance worked out and your surgery was successful. I don't think I could post about the insurance companies with the sensibility and apparent sanity you did. Hope all is going well. 

  • Hi Joes, I am devastated with the news I received today - surgery for ADR denied by my private insurance, Anthem Blue Cross. Any suggestions on how to appeal? I am in a workers comp case, which makes everything more complicated. Workers Comp has approved fusion for my C5/6-C6/7 and I am refusing fusion (as you had mentioned, I also have a passion for outdoor activities). I do NOT want to have any restrictions or problems with the levels below or above which fusion can cause. I am an avid competitive runner - been running since second grade. I have only been out of commission in the past for a meniscus repair - had surgery and was back on the trails shortly after. Now, I have been out of commission for 162 days. NO ONE understands my constant pain and that my neck can barely hold up my bowling ball of a head. I have done physical therapy, chiropractic, and their ridiculous medication. I don't want drugs and want to be fixed. How can they say "it's not medically necessary" and that is why I am told it was denied. I have an attorney... whole 'nother story. I just am sick about getting it denied by my private insurance. My pain is exasperated from crying all afternoon. Any suggestions are beyond appreciated. 

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