Dr. Regan and ADR Explant Surgery

[Jim M2]

I just told Dr. Regan's office I want to move forward with surgery.

Yesterday I spoke with Dr. Regan for a forth opinion on how to handle my situation. I remembered hearing him at a GPN seminar 10 years ago. Also Mark recommended that I should see Dr. Regan for an expert opinion. In the end I decided he is the best doctor for the surgery.

For my symptoms Dr. Regan was able to find good correlation to the imaging. The right facet is at end stage of degeneration. The ADR core is deformed. It is pinched in the back and not floating. What I thought was L4-5 discogenic pain is not discogenic pain. It is almost certainly compression and positional compression (i.e. sitting/standing) that loads up the L5S1 facets. Things are further aggravated by cysting and bone growth. As the discussion went on Dr. Regan kept returning to the MRI and pointing out pathologies and how he deals with them. I was very impressed. Mark was with me and made key observations and clarifications. I thank Mark from the bottom of my heart for finding the right doctor and keeping the dialog moving. After the excellent outcome I wouldn't dream of doing it alone. It's such scary decision and there are many risks but now everything has fallen into place.

I had despair, now I have hope.

Thank you Mark!

[vnf]

Need to remove for personal reasons

[Maria]

Jim,
So glad to read that Mark was instrumental in helping you get pointed in the right direction with Dr. Regan and that there was clarification and/or explanations of what's going on and something that can be done about it!

Will your insurance cover your explant? I can't remember if you had your ADR done in the US or not or with or without your insurance authorization. Anyway I do hope insurance covers it.

Please keep us informed on your surgical date!

Maria

[henry4956]

I know the darkness and despair that accompanies hopelessness. Soon your hope will turn into joy

God Bless

[Jim M2]

Thank you for the encouraging replies.

I had the implant in Germany. I petitioned my insurance for re-imbursement after I returned home. They paid 90%.

My insurance does not require pre-approval for the one procedure code to explant the artificial disc. There are many associated procedure codes and the hospital stay for which pre-approval is necessary. Very frustrating.

[vnf]

Jim

One thing to consider....ask the doctor for his personal email.

I've read sooo many times about people who cannot reach their doctor after
their surgery when they are having a problem and want to discuss it with THE DOCTOR. It seems that the doctor is very busy with the next surgery but then you can't have access to them anymore.
I find that frustrating. I paid for the doctor...not the staff.
Back in my post op days, when I discussed this with Dr. Boeree, he was so confident that I wouldn't have any problems, he gave me his home phone, cell phone, email, everything just to make me feel better.
I told him this pre op because I was very worried about it because I had seen so many people post this online.
Speak up now and ask for a way to reach THE DOCTOR.
The staff is overworked already and to be honest, someone who is not in pain doesn't have the urgency that the person is pain has!
I don't know about now but back when I was considering doctor's, even Clavel gave me his cell phone. Dr. Zigler gave me his personal email when I was talking with him.

It's a big concern to me and I let them know it right up front.
Already told Zeeger's the same thing.
I'm paying for the doctor not the staff. He understood and told me not to worry. We'll see but I did make him aware so I hope he sticks to it.

Just my opinion but this is a big concern to me.

[Jim M2]

Hi Vicki,

I think asking for Dr. Regan's email is great advice. Thanks,

[Jim M2]

The explant to fusion surgery is scheduled for Aug 6, two weeks from today. I took the earliest date they offered. It will be at St. John's in Santa Monica. That's all I know at this point. Here's some questions for those who have been in the hospital lately.

When should I stop taking Ibuprofen?
Can my wife and daughter stay overnight in the hospital room?

I'm sure I'll have many more questions over the next two weeks.
Thank you,

[fuzzy]

I wish you the best for your upcoming surgery, Jim.

[Maria]

Hey Jim,
Generally with any surgeries it's recommended to stop Nsaids at least 14 days prior to surgery. It sounds like you'll have time to do that. You should call and verify this with Dr. Regan's office in case that's not the case.

Re wife/dau in room I would imagine it depends if you're getting a private room? Are all rooms at St. John's private? It's been a long time since I was there. You can call the hospital and ask about spouse/dau staying overnight because I'm sure they have a policy with regard to that and can answer that question for you. It may be that you can only have one person stay in the room with you and if so hopefully there will be a reclining chair or a cot can be brought in.

[Jim M2]

Thanks Fuzzy.

Maria, I called Dr. Regan's office and they told me to stop taking Ibuprofen and any other blood thinning medications right away. They are sending out an info package tomorrow.

___
Here's something new to me. For a PLIF my boss said he was transported by ambulance to a rehab center where he stayed for 2 or 3 weeks after leaving the hospital. I asked Dr. Regan's office about this and he said they would recommend a rehab center near the hospital. OMG!

[Maria]

Hey Jim,
Surgery date is coming up pretty soon.. have you heard anything else? Any other news about the rehab facility? I think if you get into a 5 star one things should go well though it's nice to have a family member or very close friend close by just in case someone has to act as your advocate. Hope all is going well~ Maria

[sahuaro]

I just saw your post. I wish you the best for the surgery and recovery.
Dr. Regan was the surgeon for my cervical ADR and I have referred other patients here to him. So I think you've made a great choice! (And it was through Mark that I was able to see him.)

By now, Dr. Regan has sent directions regarding medications to stop and you've had your pre-surgery physical. My surgery was at a different hospital, so I don't know the policies at your hospital.

Barbara

[Jim M2]

The insurance pre-approval didn't come through. They took me off Dr. Regan's schedule until the pre-approval does come through. I'm very disappointed.

I haven't heard a thing from Dr. Regan's office about preparations for surgery.

I appreciate the kind thoughts from everyone.

[sahuaro]

Ugh! How frustrating! Do you have any idea when your insurance will respond?

While you are waiting, please ask Dr. Regan's office if you need to have a pre-surgery physical exam by your primary care. If so, you can get that done during this wait phase.

[runner]

Jim,

Sorry your surgery was postponed. I have had my surgery postponed before, no fun. I haven't been on here in a while, but decided to pop on tonight.
I haven't had an explant, but I do have 2 ADRs. They do appear to be working correctly, but something is wrong at L5/S1 in my case. If you need to fall asleep, you can read my thread if you want. I am kidding, but I wanted to lend my support and hope you get what you desire soon. My last surgery, it was postponed because I had a bacterial infection. Luckily, i did not have an insurance problem with that one, but I did before. So good luck.

runner

[Maria]

Jim,
Sorry this happened to you especially when you are told to stop your Nsaids or meds two weeks prior to surgery and made arrangements re work for time off and your wife was well plus arrangements for care.

In the "olden" days or back when I was having surgery particularly I guess because it was WC authorizing, scheduling wasn't done until the authorization had been obtained and then that was good only for a certain amount of time (which I cannot recall now). To me that seems like the safest bet re scheduling especially in terms of all that the patient has to go through with personal arrangements.

I do hope you will get the authorization (every aspect of it that is) and surgery will be scheduled and performed in a timely manner. Sorry you had to go thru this emotional upheaval and any upheaval of your schedule and your family's.

Do take care~ Maria

[Jim M2]

Okay, here's the skinny. Blue Cross Blue Shield is waiting on more documentation from Dr. Regan's office before giving pre-authorization. They only pre-authorized removal of the ADR. Generally they don't authorize fusion if the radiologist report doesn't mention instability at that level. Here are some of the other billing codes submitted by Dr. Regan.

22865 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar
20936 Autograft for spine surgery
22612 Lumbar spine fusion
21842 ?
20930 graft for spine surgery

I'm really bummed out. Who knows when they will get around to dealing with BCBS. I'm sure Dr. Regan has plenty of patients that fall in the category of low hanging fruit.

Barbara - that's a great idea. I'll ask about the pre-surgical physical tomorrow.

runner - Thanks for the thoughts. I read up onparts of your thread, it's a long one!

Maria - I remember some of your issues with pre-authorization. I've been off the NSAIDS for almost 3 weeks now. I'll be ready to go.

[Maria]

Jim,
I actually had a 2 level ADR authorized two times .. first with a surgeon at UCSF and he had shoulder surgery and trial was stopped before my surgery was happening. 2nd time Surgeon in Dr. D's office didn't send back information to WC in timely manner (he had 3 months to submit information) so that authorization was off the table. Took 2 years to get a surgery authorized again and by then I wasn't a candidate for 2 level ADR.. rather ADR and fusion. At that point I was going to go back to the same surgical office but not with same surgeon. It may not have been the surgeon's fault but that didn't matter to me at the time.

Sometimes it's the Dr.'s office and sometimes the insurance company.. sometimes it's the patient I don't think it will be the latter in your case. Hope you don't have to wait too long! Maria

[nomorepain]

interesting situation, I sometimes wonder what happens if the adr breaks down, or my spine around the adr.

[Maria]

Was wondering if you heard anything yet Jim though I guess not or you'd update. Frustrating situation is what I would call it. Hope you'll get good news soon.

[Jim M2]

Hi Maria,

I just received a copy of the denial letter that was sent to Dr. Regan's office. It came in the mail yesterday. Now that they have the letter Dr. Regan's office will know how to react.

[Jim M2]

Dr. Reagan's office let me know today that he is scheduled for a peer to peer discussion with BCBS tomorrow, Friday 8/22.

[sahuaro]

That is good news. I was not afforded that kind of review by my insurance.
It also means Dr. Regan's staff has been busy on your behalf.
Good luck and please let us know.

[Maria]

Wishing you the best there as it sounds like Dr. Regan is working to make this happen. Hope you get the auth and surgery is soon rescheduled.

[Jim M2]

BCBS told me they could not contact Dr. Regan when they called on Thurs 8/21 for the peer-to-peer. No wonder, the peer-to-peer was scheduled for Fri 8/22 according to Dr. Regan's office. ???

Because BCBS could not get hold of Dr. Regan their process closed the claim. I don't know if Dr. Regan's office is aware the claim is closed, they won't return my calls.

Back to square one. They need to resubmit everything to get a new claim going.

[mmglobal]

Jim, I don't know if the problems are from BCBS or Regan's office. For this surgery, he's the guy with all the experience that is so valuable. Regardless of where the problem is, I hope you'll keep your eye on the prize and simply work through the process, however f'ed up it is.

Insurance nonsense has been one of the most frustrating aspects of dealing with spine patients and the medical community. There is no reasonable excuse for how screwed up the system is.... it's been like this for the 2 decades I've been in this game.

Good luck... thanks for keeping us posted.

Mark

[Jim M2]

Dr. Regan is the only surgeon who will touch my spine. The root cause of the problems are on the side. They have given me other bad information such as my cancelled surgery date was 8/8. It wasn't 8/8 it was 8/6. I just want to let Dr. Regan's staff know what they are dealing with.

[vnf]

Jim

I can tell you that I'm not impressed with Regan's office.
I was told Natalie the surgery scheduler would contact me.
She never did, I ended up calling her.
I sent her a copy of my insurance card and asked her to call me and tell me that she received it okay. She never did, I had to call and ask if she received it.
"oh, let me check..oh ya, I see it"? You don't check your email for a week?
Then I asked how long the process usually takes to get an answer back from the insurance company which I was told is usually about a week.
Still haven't heard anything.
Sent an email asking what the status was.
Still haven't received an answer.

Sent Magda an email asking her is she could ask the doctor a question for me.
Told her what the question was. She sent me an email back asking me if I wanted to pay for a $325 office consult to have the doctor call me.
One question could not be asked without a consult fee?
They are supposedly scheduling my surgery and I couldn't ask a question?

I'm not really impressed at this point.

Hey US doctor's, the overseas doctor's respond to email within a day or two.
Many gave second opinions for free.
I have asked Zeeger's a zillion questions....he has no problem with this.
Hmmmm I wonder why we keep going overseas!