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View Full Version : Surgery option eliminated due to Insurance denying Forteo for Osteo



TwinmomTN
08-19-2011, 05:42 PM
Well, it looks like any possibility that I had for surgery is probably gone now since insurance will not cover the Forteo that is required in order to have a good surgical outcome. Gone are all hopes of living a decent quality life with my 10 yr. old twins. Insurance denied it initially, Dr. office wrote a letter of medical necessity explaining that this is required in order to receive a positive surgical outcome with osteoporosis. Insurance has denied based on "did not meet established prior authorization criteria defined by your prescription plan; current plan criteria only allows coverage of Forteo for a diagnosis of primary osteoporosis if patient" has a history of osteoporotic fracture; has failed or is unable to tolerate other available osteoporosis therapy, or has more than 1 risk factor for fracture". I am such an idiot for assuming for months now that I was going to be able to have this surgery even though I have osteoporosis. I feel like such a fool.

Susie*Bee
08-19-2011, 06:19 PM
Don't give up all hope yet. Sometimes your doctor can continue to push. And you can call and write letters and explain the situation. Keep on fighting. Sometimes it could be a matter of them not understanding the facts/situation. And sometimes it could also be that you need to talk to different people. Keep fighting for yourself. I'll be praying for you. I know this must be super frustrating and disheartening, to say the least. Just don't give up all hope. Hugs...

Doreen1
08-19-2011, 06:37 PM
There are other meds that folks have taken in addition to taking a non-med route using supplements. Linda, the forum moderator, posted a while back how she took supplements and turned her results around. Press your surgeon for options because there is a way. Many prayers for you. :)

Warmly,
Doreen

Doreen1
08-19-2011, 06:44 PM
For those of you who are currently or have in the past been prescribed Forteo, who was your surgeon? Have any of you been initially denied by your insurance but then approved by your insurance? What was done/said to your insurance to change their decision?

Warmly,
Doreen

mabeckoff
08-19-2011, 08:30 PM
Maybe look to change your surgeon. Find someone who will do the surgery now

Melissa

TwinmomTN
08-19-2011, 08:55 PM
Hate to be so stupid, but anyone have contact information for the forum moderator Linda? I don't get an e-mail address
through the "contact us" at the bottom. Anyone have her e-mail?

LindaRacine
08-19-2011, 10:47 PM
After I was diagnosed with osteopenia, I went on a high calcium diet, supplemented with 2 or 3 different types of calcium daily. It took a few years, but my last two DEXA scans were completely normal.

TwinmomTN
08-20-2011, 09:24 AM
Linda, do you mind sharing what your osteopenia score was? I didn't know it was possible to improve it without meds.

Doreen1
08-20-2011, 09:42 AM
Your insurance stated: current plan criteria only allows coverage of Forteo for a diagnosis of primary osteoporosis if patient" has a history of osteoporotic fracture; has failed or is unable to tolerate other available osteoporosis therapy, or has more than 1 risk factor for fracture.

What is their definition of "risk factor for fracture?"

Have you asked your surgeon for an alternate med? I've heard some folks here have taken Evista which, according to my insurance plan, does not require the special pre-authorization from the insurance carrier. If you surgeon can get you on another med and it works, great. If the other med doesn't work, then wouldn't you qualify under your insurance statement of "...has failed or is unable to tolerate other available osteo therapy?"

Just trying to help you think of options. :)

Warmly,
Doreen

Susie*Bee
08-20-2011, 12:06 PM
Yes, I took Evista and also 1500 mg of calcium with vitamin D (2 500 mg in the AM and 1 in the PM) and my dexa is normal now. I just stopped the Evista but will continue with the calcium. It did take a few years though...

LindaRacine
08-20-2011, 01:33 PM
Linda, do you mind sharing what your osteopenia score was? I didn't know it was possible to improve it without meds.

-1.5

--Linda

LindaRacine
08-20-2011, 01:43 PM
-1.5

--Linda

I just found the report from my last DEXA. The T-scores ranged from 1.1 to 1.4.

jrnyc
08-20-2011, 02:04 PM
i have osteopenia...and was told it would not prevent my having the
fusion surgery...

i did not know any of it was reversible...to me, that is pretty amazing...
but i am wondering if it is osteopenia that is changeable...not osteoporosis....

is there a limit to how much calcium one may take...?
are there side effects from taking a lot of calcium...?
just wondering...i am going to start looking this stuff up on the internet...

jess

loves to skate
08-20-2011, 04:06 PM
i have osteopenia...and was told it would not prevent my having the
fusion surgery...

i did not know any of it was reversible...to me, that is pretty amazing...
but i am wondering if it is osteopenia that is changeable...not osteoporosis....

is there a limit to how much calcium one may take...?
are there side effects from taking a lot of calcium...?
just wondering...i am going to start looking this stuff up on the internet...

jess

Jess, I think even osteoporosis is reversible. Yes, you can overdose on calcium and it would cause cardiac problems according to my PCP back in Massachusetts. Go to the best websites on the internet such as WEBMD or the MAYO Clinic, not just any website.

TwinmomTN, There are several medications that are now generic that will help reverse osteopenia.

Sally

jrnyc
08-20-2011, 05:38 PM
thanks for the info, Sally

jess

Karen Ocker
08-20-2011, 06:15 PM
I consulted a metabolic bone specialist when some jerk of a radiologist read my X-rays as "profound demineralization of the skeleton". I became very frightened because this was a couple of years post-op. The glare from the hardware obstructed his view.
The specialist diagnosed me with osteopenia but said I did not need any bone-building meds. She did find low Vit D even though I WAS taking calcium and vit D. I then was advised to take 1800units of vit D/daily. she also checked my parathyroid function which is involved in bone metabolism.

Anecdotally, one lady, diagnosed with low bone density, decided against bone meds and got her bone density up at the gym. By the next visit to her doc she didn't need meds.

A forum member suggested finding a doc who would do it now but what if you do not fuse properly and the hardware doesn't hold???

mabeckoff
08-20-2011, 06:49 PM
A forum member suggested finding a doc who would do it now but what if you do not fuse properly and the hardware doesn't hold???[/QUOTE]

That was me.My doctor said that he would be willing to look at her records and see whether or not he felt that he could do her surgery

There is no guarantee that fusion will happen in any case

Melissa

TwinmomTN
08-22-2011, 07:36 PM
What generic meds will reverse osteoporosis? I was told the only to help improve enough for surgery is Forteo.

Kayde
08-22-2011, 09:07 PM
I took high dose of supplements and went from severe osteoporosis to normal and borderline osteopinia in left hip in 8 months. My t scores at it's worst was -4.7. It is possible to restore Never took supplements before this and I believe in them now. Don't give up. Going to surgeon in september and see if he will do the surgery.

Doreen1
08-23-2011, 07:14 AM
I came across this thread about reversing osteopenia/osis without using meds http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/success-stories-w-o-drugs/

Interesting.

Warmly,
Doreen

loves to skate
08-23-2011, 09:17 AM
What generic meds will reverse osteoporosis? I was told the only to help improve enough for surgery is Forteo.

Check out the Mayo Clinic and WebMD web sites for osteoporosis medications. I was taking Alendronate for my osteopenia. Probably Forteo works best, but that doesn't mean that the other meds don't work.
Sally

LindaRacine
09-13-2011, 12:17 AM
I didn't want to say anything until we kicked off the study this week, but if you're interested in traveling for surgery to UCSF, we're doing a study of Forteo and spinal fusion. You can read about it here:

http://clinicaltrials.gov/ct2/show/NCT01292252?term=teriparatide+spinal+fusion&rank=1

--Linda

jrnyc
09-13-2011, 01:32 AM
am searching for the right calcium to take...
(i cannot take anything like Actonel or Forteo as i am still getting
dental implant work done, and will be for about another year)...
also need to find doctor in Manhattan who specializes...i
think my gyn once gave me a name and i need to ask her for it
again...
has anyone heard of Ezorb?

"One month supply, 180 gelatin capsules, normal size, light weight,
easy to swallow. Each contains 560mg calcium aspartate anhydrous"

???

thanks...
jess

Pooka1
09-13-2011, 06:41 AM
has anyone heard of Ezorb?

"One month supply, 180 gelatin capsules, normal size, light weight,
easy to swallow. Each contains 560mg calcium aspartate anhydrous"

???

Jess, are you asking what form this is?

Aspartate is an amino acid and anhydrous means no water molecules attached.

Calcium has a plus two charge and so has to be combined with a negative ion of minus two charge to have a neutral final complex. The amino acid is a good choice it seems.

The point is to get the calcium into the body in a form that can be used.

Mojo's Mom
09-13-2011, 08:04 AM
TwinMom, DO NOT GIVE UP. Show your surgeon what the insurance company responded with, see what he says. Your insurance company should have an appeal process. Another osteo med might work as well or nearly as well. You have options. Don't give up.

The health care system can seem very adversarial at times, and we have to fight for what we need.

jrnyc
09-13-2011, 08:19 AM
thanks, Sharon...
sounds complicated...
i have a head for social work/education/psych...not for science...

so i guess it is a good source for calcium...

jess