Guaranteed Healthcare

I have some comments on my story on the NRP radio program, the Story with Dick Gordon, that aired Tuesday (Nov. 18)...

First of all, I have to say I am grateful to the people at
the National Public Radio's The Story with Dick Gordon for telling my
story.

This has been a long journey and I have not posted on my blog for
some months. I am now eight months post-op. I had Artifical Disc
Replacement (ADR) in my lumbar spine at lumbar disc 4/5 and my health
insurance company Blue Cross of California refused to pay for my
surgery.

After many delays and postponements, I had surgery on March 11,
2008. I found out after my surgery from the hospital finance dept
that my surgery was authorized but afterwards when the hospital
contacted Blue Cross, the insurance company refused to pay for it as
it was deemed "experimental" and "investigational".

ADR surgery is not "experimental" or "investigational",
two terms that insurance companies like to throw out, because it is
FDA-approved. Other insurance companies routinely cover single level
disc replacement and Blue Cross has also approved the surgery for
other patients, but not me.

Currently, there are two FDA-approved lumbar artificial discs and
they are Charite (2004) and ProDisc (August, 2006). I had ProDisc.
There are other discs that are not yet FDA-approved, but people have
received them in clinical trials. There are also other discs that
have been implanted in patients in Europe and in other countries.

Secondly, my fight against Blue Cross has not been a lone
pursuit. The California Nurses Association (CNA) has given me
invaluable help. I remember feeling like I had no where to turn and
people at CNA offered me help. Also people on the internet have been
my support system and the "Insurance Warrior", Laurie Todd,
has given me advice that I used in my appeals to Blue Cross. I want
to make a point of this because without these people I would have
stopped fighting BC and had fusion or decided to live my life on
disability and not been able to get off the narcotics because of the
pain.

My church family, who paid for a baby-sitter for my three-year-old
son for the first six weeks after I came home, has been great and
supportive of my family and I. Also my friends and my siblings kept
me going when I was going to stop from frustration.

I also have to point out that surgery is not a slam dunk ever and
should only be undertaken when it is emergent or like with my case,
the pain is so bad that you are prevented from living your life.

Thirdly, I am so happy I had the surgery, even though I
have had to battle my insurance company. I am in a lot less pain and
have been able to get off the heavy narcotic medications I was taking
for months. My thoughts are much more clear now. My surgeon and me
wanted ADR because with ADR there is about a third the chance of
developing disease in adjacent discs than with fusion.

I am eternally grateful to my surgeon for his skill and care. As I
continue to heal from this major surgery, I look forward to being
able to do more things. Last weekend, I went to the movies and was
able to sit for the whole movie. That is not something I could do
before my surgery.

Still, it amazes me that Blue Cross has denied ADR surgery for so
many people. BC has not "approved" my surgery but I believe
I have made some inroads to getting them to approve it. Who knows,
maybe they will wake up and see how less expensive ADR surgery is
over the long run.

Like I said in the radio program, my health is more important than
anything and I will not let some insurance company dictate what is
best for me over what my doctor says is best.

We need to put health care decisions back in the hands of doctors.

For those out there fighting insurance companies, I have one thing
to say, "Keep Fighting".