[annapurna]

For those of us with regional HMO's, insurance reimbursement of ADR and other motion-preserving spine procedures are limited not only by general insurance company policies, but also by local availability of skilled surgeons.

If I want insurance reimbursement for any medical procedure, I can only go to providers in my local area, which includes northern Utah. So, if there are no ADR surgeons in the greater Salt Lake City area, I'm paying in cash regardless of what the FDA or any other policy-makers say.

As employers get pushed harder and harder by increasing medical insurance costs, they tend to shift from "open" plans like PPO's to HMO's, which are regionally-restrictive. I'm lucky in that I have a high enough income that I can pay cash when necessary, but I've still needed to sacrifice to get my L5/S1 Charite and c5/c6 Prodisc. My husband and I rent an economical apartment and own one, aged Toyota between the two of us. We have no children. All the money that our friends spend on vacations, toys, homes, cars, and kids gets poured into my spine.

It's a bit scary to consider that the progress of medical technology may be limited in the future not because the advances are not needed, but because no one is able or willing to pay for them. I'm grateful that I've been blessed with the ability to make that choice for myself and wish that it was possible for everyone to do so.