National Insurance Carriers Now Cover Artificial Cervical Disc Surgery
April 24, 2009 by ldombro
Filed under Spine Featured
For more than a decade, Virginia Sabine endured. But the vibrant 40-year-old wanted more than unbearable neck pain and addictive medication. She wanted her life back.
In 1996, Virginia had two discs fused. Now a third disc was acting up, and she went hunting for answers. She found them in Geoff Dixon, M.D. an experienced neurosurgeon with the Chicago Institute of Neurosurgery and Neuroresearch (CINN). He recommended an artificial disc for the cervical (neck) region that was unanimously approved by the Food and Drug Administration in July 2007. Neurosurgeons at CINN are among the most well-trained surgeons in the country in performing cervical artificial disc surgery and frequently are asked to teach other spine surgeons in the technique.
“The decision to go with artificial disc replacement was easy,” Virginia says. “Not only was the procedure covered by insurance, but the benefits far outweighed spinal fusion.”
She says that the difference between the artificial disc operation and the fusion was night and day. “In 1996 I was in the hospital for five days and in a neck brace for two months. This time I was out of the hospital and walking immediately and the pain was completely gone within four days.”
U.S. health insurers, too, see the same benefits in artificial cervical disc surgery that Virginia did. As a result, today they are extending coverage to a broad base of customers.
Now 200,000 Americans with spinal disorders have potential access through insurers such as Aetna, various BlueCross BlueShield plans and Broadspire to artificial disc surgery instead of the conventional cervical spinal fusion surgery. Other insurance carriers may approve the innovative procedure on a case-by-case basis.
Currently, the most common surgical treatment for patients with degenerative discs in the cervical spine is spinal fusion. In this procedure, a surgeon removes the damaged disc then implants a bone graft and metal plate to fuse the vertebrae together. Challenges of spinal fusion include longer recovery time, pain management and the possibility of adjacent level surgery in the future.
During artificial disc replacement surgery, the damaged disc is removed and replaced with an artificial disc, a stainless-steel device with a ball-in-trough design intended to allow for replication of normal motion. The disc stays in place with bone screws. The hospital stay for this procedure is approximately one to two days. Patients can begin rehabilitation and return to daily activities soon after surgery. In fact, one study demonstrated that patients receiving the cervical disc returned to work in 45 days, 16 days earlier than the fusion patients.
“Studies show that artificial cervical disc patients have a higher rate of neurological success as measured by muscle tone, strength, sensation, as well as responsiveness of reflexes as compared to those who’ve had spinal fusion,” says Dr. Dixon. “Studies also demonstrate that at a two-year follow-up exam, the overall success rate for the artificial disc group is 79.3% compared to the fusion group at 67.8%. These reasons are compelling enough for potential candidates to consider the option of an artificial disc.”
The Chicago Institute of Neurosurgery and Neuroresearch is one of the nation’s leading organizations for the diagnosis, treatment and rehabilitation of people with brain and spine disorders. Founded in 1987, CINN is one of the Midwest’s largest teams of neurosurgeons, physiatrists and neurologists known for their pioneering treatments in minimally invasive techniques. Through a network of seven hospitals throughout Chicagoland, CINN is a market leader in treating brain tumors and spine disorders.
For details on the cervical artificial disc, call: 1-800-446-1234 or visit www.cinn.org. The following insurance carriers have issued a positive coverage decision on the Prestige Cervical Artificial Disc:
Aetna-National
Avera Health – SD, IA, NE
BCBS Horizon – NJ
BCBS Illinois
BCBS Montana
BCBS New Mexico
BCBS Oklahoma
BCBS South Carolina
BCBS Texas
Broadspire
Brown and Toland IPA – CA
BSBS North Dakota
Builders Insurance Company – NV
Community Care of OK – OK
Cox Health-MO
Dean Health Plan-WI
Employers Insurance of Nevada – NV
Gunderson – Lutheran Health Plan – WI
Highmark BCBS – PA, WV
Lovelace Health Plan – NM
Medical Mutual - OH
Montana State Employee Fund-MT
Motion Picture Association-CA
ODS Health Plan
Pacific Source-OR
Physicians Plus – WI
Premera WA, AK (also administrators for LifeWise AZ, OR)
Priority Health of Western MI – MI
Public Employees Benefit Program – NV
Public Employees Health Plan of Utah – UT
SelectHealth – UT
Willis-Knighton Health Plus – LA
Writer’s Guild-CA
I live in Philadelphia, PA and had a Cervical Disc Replacement (C3-C4) on February 19, 2009. The procedure was performed by the Rothman Institute at Thomas Jefferson Hospital.
My insurance carrier is Independence Blue Cross, Personal Choice. Certain services are covered by Highmark Blue Shield. The insurance company denied coverage. I understand it was my responsibility to pay $6,000. for the Pro Disc-C manufacured by Synthes. The insurance company would have paid all medical bills if I elected to have a fusion. A fusion would have limited the range of my in my neck.
Can anyone help me convince the insurance company to pay the hospital bills for my cervical ADR?
Thank You
Richard
IT’s ridiculous that BCBS of some states covers the procedure and in other states disallows the surgery! I live in Florida - backwards and nonprogressive!
Or…do I need to move to another state to get help and continue to work as a teacher?
I was in a car accident June 4th 2009. I broke 2 discs in my neck. This all happened while I was living in LA. I had surgery June 9 and recently came back to Chicago to stay with family for my recovery. I am now looking for a doctor to treat me with my injury. I am wearing a halo until about the 2nd week of September. Does anyone know a good neurosurgeon I can see in Chicago?
I have been fighting Carefirst BCBS of MD for coverage since Oct. 2008. Our local NBC affiliate ran a story of the benefits and life changing effects of artificial cervical disc replacement tonight. Unfortunately Carefirst BCBS is the largest provider in our area. Aetna & Kaiser both cover it in my area. So does BCBS in surrounding states, PA, WV, NJ and BCBS Federal Employees. I have not switched to another plan because there is a 1 year waiting period for a pre-existing condition in most plans. Additionally, since I am self-employed, I have to undergo underwriting. If I was offered a plan with a different carrier, the premiums would most likely be cost-prohibitive and I would still have to wait a year. My guess is that since there are now 2 ACD devices approved by the FDA, there will be more pressure put on insurers to cover the cost. I am hoping that will come sooner rather than later.
It’s interesting. As a physician assistant I get an incentive check every year from some insurance carriers including the Blues for writing generic medicine and having a low percentage of patients seeking care at the Emergency Department. Its small potatoes compared to what I have saved them and my patients. Just had 2 disc replacements in my cervical spine and doing great, except the enormous bill for the surgery. There was a time that hip fusion was standard of care. Filled an appeal. Who knows?