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UHC said NO to BMP surgery. Good Bye everyone - for now

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  • UHC said NO to BMP surgery. Good Bye everyone - for now

    United Health Care denied my surgery with Dr Bridwell, he was not very hopeful. I was surfing the web and found many surgeons declaring that 2012 has been more and more challenging as insurance companies are starting to deny any or all surgeries involving BMP or similarly classified as experimental or investigative procedure. Many surgeons posted that PEER TO PEER is a joke as the medical director on the insurance side will make the our surgeons present lots of documention but at the end they will stick to the policy dictated by guidelines.

    So, I have asked Dr Bridwell directly if he is dropping me as a patient as I am not to win and waiting is just never ending and not healthy.

    I am starting to look for alternative major surgeons that uses other methods other than taking bones out of my body, and apparently taking from cadavers are risky for infection or rejections.

    Just moving along... Good look to all of you that still have an opportunity to have the surgeon, it is not for me in St Louis. Back to the drawing board which takes a lot of expense, pain, frustration, and energy.
    Gardenia
    Baja California, Mexico & El Centro, Ca
    pre-surgery 75° and 89° - post ?
    Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
    T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

  • #2
    I am so sorry for you. BCBS covered my surgery last July which cost over one million dollars. My surgeon used BMP and they just approved my surgery in 2 weeks. Dr Bederman will be using BMP then as well. I hope that you can find some relief
    Melissa

    Fused from C2 - sacrum 7/2011

    April 21, 2020- another broken rod surgery

    Comment


    • #3
      Gardenia--
      How discouraging! I'm so sorry about this. I wish I had some answers for you. I hope your search will find something promising. Thinking of you. Janet
      Janet

      61 years old--57 for surgery

      Diagnosed in 1965 at age of 13--no brace
      Thoracic Curve: 96 degrees to 35 degrees
      Lumbar Curve: 63 degrees to 5 degrees
      Surgery with Dr. Lenke in St. Louis--March 30, 2009
      T-2 to Pelvis, and hopefully all posterior procedure.

      All was posterior along with 2 cages and 6 osteotomies.

      Comment


      • #4
        What was United's reasoning?

        Any chance of switching insurance carriers?

        I don't think there is anything for fusion besides BMP, autograft (your own bone) and allograft (cadaver bone). I'm not an expert, of course. But I don't get how they can just flat-out deny.

        Evelyn
        age 48
        80* thoracolumbar; 40* thoracic
        Reduced to ~16* thoracolumbar; ~0* thoracic
        Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
        Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
        Not "confused" anymore, but don't know how to change my username.

        Comment


        • #5
          I am so sorry to hear that, Gardenia. I, like Evelyn, hope you can switch insurance carriers.
          I am stronger than scoliosis, and won't let it rule my life!
          45 years old - diagnosed at age 7
          A/P surgery on March 5/7, 2013 - UCSF

          Comment


          • #6
            My understanding is that WashU will pick up the cost of BMP if the insurance company won't pay for it.
            Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
            ---------------------------------------------------------------------------------------------------------------------------------------------------
            Surgery 2/10/93 A/P fusion T4-L3
            Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

            Comment


            • #7
              Gardenia,

              Dr. Gaines in Columbia, MO is a world renown surgeon and specialist is scoliosis and spinal deformities. He does not use synthetic bone materials, but only uses your bone materials. I would encourage a visit with him if you are possible. He. Is out of Columbia Orthopedic Group.

              Tamena
              Diagnosed at age 12 with a double major curve

              Braced till age 15

              SSBOB T12-L2 Anterior age 34. (October 22,2012) Dr. Robert Gaines Jr. ( Columbia, MO)

              Revision Surgery T2-Sacrum with Pelvic Fixation Prosterior age 35 (November 13,2013) Dr. Michael Kelly (St. Louis, MO)

              Revision Surgery L4/L5 due to BMP Complication age 36 (November 20,2014) Dr. Michael Kelly (St. Louis, Mo)

              Revision Surgery due to broken rod scheduled for October 19, 2016 with Dr. Michael Kelly (St. Louis, MO)

              Comment


              • #8
                So sorry to hear about that. You were all set and excited. Bummer.
                Susan
                Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

                2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
                2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
                2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
                2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
                2018: Removal L4,5 screw
                2021: Removal T1 screw & rod

                Comment


                • #9
                  Gardenia,
                  I truly feel for you. I can't imagine how disappointed and frustrated you are.
                  Karen

                  Surgery-Jan. 5, 2011-Dr. Lenke
                  Fusion T-4-sacrum-2 cages/5 osteotomies
                  70 degree thoracolumbar corrected to 25
                  Rib Hump-GONE!
                  Age-60 at the time of surgery
                  Now 66
                  Avid Golfer & Tap Dancer
                  Retired Kdgn. Teacher

                  See photobucket link for:
                  Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
                  Before and After Picture of back 1/7/11
                  tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
                  http://s1119.photobucket.com/albums/k630/pottoff2/

                  Comment


                  • #10
                    I was sorry that I read this post... but I hope you continue with the forum. Best wishes to you. Please keep us updated
                    Best,
                    Heidi
                    Scheduled for surgery with Dr. Lenke Oct. 2012
                    53*T 71*L
                    Surgery 10/05/2012 T4-pelvis
                    Correction: looks perfect! Will find out how perfect at future appointments

                    Comment


                    • #11
                      Gardenia, I'm in the same boat. Im self employed, have bad insurance, they said they'd pay about $6,000 toward surgery. What a joke. I was set for surgery with bridwell in 2010 and he cancelled the DAY BEFORE surgery. I never really got a straight answer, but I assume it had to do with money. I feel for you, and know what you're going through. If you make any progress or find something that might help, PLEASE let us know. Good luck.
                      Pre-surgery- 80°+ thoracic/ 60°+ lumbar
                      Still unsure of post-op numbers
                      37 yrs. old, 6'7" ish
                      Scoli pics

                      Comment


                      • #12
                        I'm so sorry to hear that. Have you gone through the formal appeal process?
                        __________________________________________
                        Debbe - 50 yrs old

                        Milwalkee Brace 1976 - 79
                        Told by Dr. my curve would never progress

                        Surgery 10/15/08 in NYC by Dr. Michael Neuwirth
                        Pre-Surgury Thorasic: 66 degrees
                        Pre-Surgery Lumbar: 66 degrees

                        Post-Surgery Thorasic: 34 degrees
                        Post-Surgery Lumbar: 22 degrees

                        Comment


                        • #13
                          i thought i read elsewhere that gardenia got approval for the
                          surgery....???

                          jess

                          Comment


                          • #14
                            going to St Louis on the 17th of Nov. surgery on the 27th

                            Jess,
                            Yes, insurance reconsidered almost immediately.

                            I am starting a new forum. Sometimes the Header and the date initially posted are misleading.

                            Gardenia
                            Gardenia
                            Baja California, Mexico & El Centro, Ca
                            pre-surgery 75° and 89° - post ?
                            Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
                            T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

                            Comment


                            • #15
                              Originally posted by mabeckoff View Post
                              I am so sorry for you. BCBS covered my surgery last July which cost over one million dollars. My surgeon used BMP and they just approved my surgery in 2 weeks. Dr Bederman will be using BMP then as well. I hope that you can find some relief

                              I just noticed this post under my Bederman search. I also have BCBS, so it is good to hear they covered it. I am curious about BMP since Dr. Bederman told me he doesn't plan to use it. I will have to follow and ack why.

                              A thank you to Gardenia who let me know BMP might present an insurance issue.

                              Comment

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