David vs. Goliath: Patients Defeat Aetna in Fight for Spine Surgery Coverage
Insurance companies have been getting away with denials for years. These denials take a serious toll on the patients who need treatment to get better. This leads to patients suffering while insurance companies grow their profits. It's like an ongoing battle of David versus Goliath.
But sometimes in the health insurance world, David pulls off an upset.
In a recent story, Aetna health insurance has just been issued by the courts to pay up to $55k to patients who underwent a one level lumbar artificial disc surgery. Aetna was claiming that the surgery was “experimental or investigational” and refused to pay for the surgery (Even though there was growing and proven evidence of the surgery, along with approval from the FDA). Despite all of this, the insurance companies still were denying the surgery, leading to patients suffering in pain, or being forced to pay out of pocket to get the surgery performed.
Following extensive litigation, a group of patients banded together to file a class action lawsuit. They were able to prove that the artificial disc replacement was medically necessary and should be covered by insurance. They showed through clinical evidence that the procedure was safe and effective in reducing patients’ pain by replacing a single level disc in the lumbar spine. This was a turning point in the insurance industry and a huge win for the common folk.
What is an Artificial Disc?
What is an artificial disc is exactly?
The spine is made up of bones called vertebrae. And in between each bone, there is a cushion called a disc. The discs in the spine allow for motion of the back without the bones rubbing against one another. Lumbar disc replacement surgery is where you go in and take out a disc in the spine, due to it being injured or having a problem, and replacing it with an artificial one. This is an alternative to having a spinal fusion performed. Surgeons often like to do artificial disc surgeries over fusions for a few reasons:
- Faster recovery than a fusion
- Reduced risk of adjacent segment disease compared to a fusion
- Better long term outcomes than a fusion
Candidates for artificial discs are generally younger patients and those that have injury of one or two discs with no major issues with the stability of the spine.
Comparing Outcomes: The Risks of Artificial Disc Surgery vs. the Benefits of Deuk Laser Disc Repair®️
Artificial disc surgery and my surgery, the Deuk Laser Disc Repair (DLDR), are very similar. Not in the way the technique performed or the outcomes, but in the way these insurance companies are treating my surgery. Just like the one labeled artificial disc “experimental” and “investigational”, they do now with the DLDR despite robust evidence proving its effectiveness.
There are some differences in the way the surgeries are performed. The difference between the two is quite simple. The DLDR is a better surgery for the patient. Artificial discs on average have about 80% relief on average in patients, where the DLDR surgery has 99.6% relief in pain.
There are more issues that can arise from the artificial disc surgery versus the laser procedure. These can include:
- Artificial disc surgery for the lumbar is made by an incision through the abdomen to access the spine to remove the disc and replace it. This is the most invasive way to do surgery on the spine.
- Complications from the surgery that include:
- Implant Migration: A shift of the artificial disc from its original position leading to nerve impingement and more surgery to fix the issue.
- Hardware Wear and Tear: The material used can wear out over time.
- Infection: Risk of infection at the surgical site due to being more invasive and larger incision.
- Vascular Injuries: Major injuries to blood vessels due to the approach of the surgery.
- Bowel Injuries: Penetration of the bowl during surgery with instrumentation.
- Ileus: Stoppage of the intestine due to the organ not working properly.
- Blood Clots: Potential risk of a deep vein thrombosis (DVT) dislodging and traveling to the lung causing a pulmonary embolism.
The Deuk Laser Disc Repair is a much safer and less invasive surgery compared to the Artificial Disc Replacement (ADR). The surgery is done endoscopically through a 4 mm incision in the back with a precise laser to zap away the herniation and relieve the back and leg pain of the patient. The surgery is done outpatient so the patient can go home the next day and does not have to stay in a hospital overnight. Zero post-operative narcotics are given after surgery as compared to having the disc replacement surgery, which leads to some patients becoming addicted to narcotics given to them for post-op recovery.
Why Would Insurance Cover the Riskier Option?
The part that amazes me is that the artificial disc surgery is effective in reducing pain in patients, but with all of these complications, how can it be affordable for the insurance companies to cover this surgery? With post-op complication ranging in 10-40% of patients after a lumbar artificial disc replacement, the cost of recovery on top of surgery would ultimately cost the insurance company more money than the alternatively safer Deuk Laser Disc Repair. Not to mention too, the ultimate cost from this invasive surgery… the quality of life for the patient. With the less advanced surgery of the artificial disc replacement and the invasiveness of it, patients like I said before, are at higher risk for developing complications post surgery, being on a chronic pain management regimen the rest of their lives, and most importantly, suffering in their quality of life.
The Future of Spine Surgery
Although insurance companies make claims about new technologies and procedures to treat people being “experimental” to deny more and more claims, they are continually proven wrong by research and the court system. When these big companies are proven wrong, it benefits the patient in their health and treatment, which ultimately as a physician is what I strive for… my patients.
Deuk Laser Disk Repair is the next gen alternative to traditional spine surgery, eliminating back and neck pain. People no longer need to be given metal and hardware by these insurance companies and can elect to be treated in a much safer, more advanced way - the Deuk Laser Disc Repair.
UPLOAD YOUR MRI FOR A PAIN FREE LIFE
If you are seeking relief from lumbar pain, have been recommended for an artificial disc replacement, or are still dealing with chronic back pain after a failed fusion surgery, we can help improve your quality of life and enable you to live pain-free.
Upload your latest MRI for a free review and a personal consultation with myself, Ara Deukmedjian, M.D., founder of Deuk Spine Institute and creator of the Deuk Laser Disc Repair® procedure.
