New Here, surgery Oct. 11, question about BMP

[Heidiv2]

Hi all, I have been lurking here for a number of months and had trouble getting accepted when I applied to become a member. First off, I have gotten so much knowledge and support from this forum, thanks to all. Even though I was unable to post and respond, I was just so relieved to find other adults facing some of these same challenges.
Here is my biggest question right now. My insurance sent a letter saying that usage of BMP is denied due to being medically unnecessary. I have Healthlink insurance and have never had any trouble with them before. I think that I understood that they use this for the spinal fusion part to help with the bone graft? I will call and talk to Kelly at Dr. Lenke's office tomorrow but was just wondering if anyone else has had difficulty getting this approved?
Thanks in advance for any replies.
I am getting REALLY nervous as the date's getting closer.....

[JenniferG]

Welcome Heidi. I had a lot of trouble getting approved also, not quite sure what that's all about. But glad you are here at last!

I live in Australia so am not familiar with your insurance policies but I would imagine BMP to be used in most fusion surgeries these days. I hope you or Dr. Lenke can petition your insurance company to cover it for you.

I'm sure someone familiar with these problems will be able to help you.

I see your surgery is scheduled in a couple of weeks. It's great that you were able to get in here to ask questions. In the last weeks before surgery, it's all we think about, isn't it? So keep the questions coming. Knowledge is power!

[Heidiv2]

Thanks for the quick reply, yes I would imagine our healthcare/insurance coverages are quite different. And Yes, the surgery is consuming my thoughts most of the time. my friends and family have got to be getting sick of me working thru this and using them to bounce ideas off of. I will say, I think my kids will be my biggest challenge after surgery.

[titaniumed]

Hi Heidi,

BMP is very pricey stuff and used for patients that the surgeon might believe would have fusion issues. (Non union) Usually, its used on older patients. You are young, you will do just fine. Direct your questions here, we promise we wont tire of scoliosis questions. lol

Welcome to the forum.
Ed

[mbeckoff]

Welcome. Please ask all the questions you want. We will not get tired of answering them.

Melissa

[leahdragonfly]

Hi Heidi,

I just wanted to say hi--I have surgery scheduled for Oct 11th also---yikes!! It is really so close now, and it certainly dominates my thoughts now. In fact I am getting ready to leave to have an MRI this AM, then meet with the surgeon after that to finalize the surgical plan.

I think the issue with BMP is it is extremely expensive. I am sure Dr Lenke's office will help get it sorted out with your insurance company.

Good luck, and please post as much as you like. These next 2 weeks of waiting are going to be tough! How old are your kids?

Take care,

Gayle

[Heidiv2]

thanks to all for responding, I am waiting for the nurse to call me back about the insurance issue. My girls are 15 mos and 6 years old. So the BMP is something that they are using but doesn't necessarily HAVE to be used from what I am reading online about it? I am an RN but work at a small hometown hospital and we don't do things like this here so am out of my league here.

[kennedy]

Hi Heidi My surgeon has a huge Research Interest In the study of BMPs in peds and adults spine surgery

[golfnut]

First of all, best of luck to Heidi and Gayle with your surgeries and Oct. 11th and their recoveries.
Heidi, I have Healthlink and my surgery is scheduled with Dr. Lenke, too. I am much older than you and hope the Healthlink will cover the BMP for me. I also will have a long fusion, but I don't know if that matters or not as far as insurance companies paying for it.

[Heidiv2]

Thanks Karen, best of luck to you also and I think that we are in terrific hands with Dr. Lenke. I just heard back from Kelly at his office and she said that she worked with the insurance and she told me to not worry about it (BMP) for now. That they had NEVER had it not get paid thru Healthlink and I would not be billed for it. Hope she is right and I called the insurance themselves. They told me that it was between the docs (theirs and mine) to get it approved. You bet your bippie I'll be keeping tabs.

[LisaB]

Hi Heidi - I had a fusion with Dr Bridwell in St Louis 4 weeks ago today; T3-L1. I had BMP approved by my insurance company, Blue Cross/Blue Shield. I'm 56, though, so that may be why. It definitely helps the fusion process. In Jan '09 I was fused from L4-S1 in Indy for spondylolisthesis and my doc here used BMP and at my 3 month checkup I had a solid fusion. The insurance companies should start approving this because it seems like it may be cheaper than having to go in and redo it if you don't fuse. Good luck!

Lisa

[Sherie]

My dd had surgery with Dr. Lenke too in '07. He used BMP on her too ( I think he uses it on all of his patients now). I don't remember exactly how much now, I know it was more than one unit. We had no problems with the insurance company paying for it. We had United Healthcare back then. I studied the detailed bill and did not really see it mentioned specifically, I wonder if they roll it in with other items? They also told me not to worry, that it would not be a problem.

[Confusedmom]

I'm glad the nurse said they would approve the BMP. There was another poster here on the Forum who had to go to Cincinnati b/c she couldn't get insurance approval for BMP, so Dr. Bridwell (Lenke's partner) would not do the surgery. I was also told by Dr. Bridwell's nurse that BMP is a necessity and they begin working on approval after your first appt. in St. Louis. I have United Healthcare and, while UNH used to routinely approve it, Bernie said they are the most difficult to obtain approval from now. I am 38 and would definitely want the BMP as it greatly reduces your risk of pseudoarthrosis, I believe! Best wishes to you; you are in good hands!

Evelyn

[Doodles]

Heidi--
I had 12 units/tubes whatever it comes in since I saw it on the order form when I requested surgery notes, etc. They told me it would not be a problem and it wasn't. Dr. Lenke thinks it is too important not to use--again it could be age here, not sure. Good luck with your upcoming surgery! Janet

[kennedy]

I think Dr gupta put BMPS in my for my bone graft also with my rib bone and donor bone for my spinal Fusion i'm not compelety sure about it