Guaranteed Healthcare

In my last post, I told about how my
back injury, which eventually ended with me receiving major surgery,
began.

What I want to talk about today is how
I have felt as I have battled my insurance company, Blue Cross of
California in my quest to get the surgery I needed.

For some reason I have felt that it is
my fault. Somehow this fight against an insurance company that
dictates people's health care not according to what they need but its
bottom line, has left me feeling empty and hopeless at times.

If this was a basketball game, Blue
Cross would be spotted 50 points at the start of the game. The odds
have been against me all the way.

Let me explain a few things.

My surgeon (a neurosurgeon) wanted me
to have what they call disc replacement in my lower back. Just like
there are knee and hip replacements, the area between the vertebrae
called the lumbar disc can be replaced. Once the diseased disc is
taken out, the artificial one put in its place acts like a joint. It
seems simple enough but it isn't.

The problem is that the back is
complicated. There are nerves and muscles and the spinal cord
itself. Sometimes back surgery can leave a patient worse off than
before surgery. Hip and knee replacements are commonplace nowadays.
Artificial Disc Replacement (ADR) is newer and the reason why my
surgeon wanted to do it is to avoid the pitfalls of fusion. Namely,
with fusion there is a risk of non fusion, possible pain from using
your own bone, and the big one, adjacent disc disease as the joint
is fused and the load is transferred to adjacent discs, which can
deteriorate and the patient needs more surgery.

My surgeon offered me a surgery with a
quicker recovery, less pain and a better prospect for getting back to
a more normal life.

Now who wouldn't jump at this? Blue
Cross won't because their surgeons, which in my case included a
retired neurosurgeon, believe in out-dated data.

Disc replacement has been performed in
Europe for more than 20 years. Many Americans go to Europe to have
surgeries because it is less expensive and the European surgeons can
do more than one level and have years of experience.

We shouldn't have to go out of our
country to have surgery and people shouldn't be forced into a surgery
they do not want and is not their best option.

The fact is that my particular disc,
the ProDisc, went through years of trial and was approved by the FDA
in August, 2006. Trials for disc replacement have been going on since
1998 in the US.

So when my surgeon and I tried to get
approval for my surgery, originally scheduled for December we were
delayed and finally denied. An appeal to the Department of Managed
Health in Sacramento was denied. One of the three doctors who
reviewed my case even questioned if I was in severe pain.

I finally told my husband that I had to
have the surgery and we might have to pay for it, but I was going to
do everything in my power to get Blue Cross to foot the bill.

Blue Cross actually authorized my
surgery on March 11, 2008. But the insurance company which says it
advocates for its consumers, does not want to pay. So the initial
bill is 137,603.22 . Recently, the hospital reduced the charges, but
it is still more than we can handle.

So you can see where guilt comes in. I
have risked my family's welfare so I could have the surgery that
would give me the best chance of getting back to work as a nurse and
getting back to my life.