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Kathleen Mosko:
First Coast Service Options
Medical Policy Department

After a decade of excruciating pain, in May of 2010, I was able to receive a 6-level minimally invasive XLIF procedure, 10 months later I had a 3-level minimally invasive ACDF procedure, followed by a minimally invasive smith&nephew Oxinium total hip replacement 8 weeks after that. Within a year my doctors were able to take away years of suffering and corrected several debilitating conditions. ALL WERE DONE WITH MINIMALLY INVASIVE PROCEDURES. HOWEVER, that isn’t the real story… by them doing the correct minimally invasive spinal fusion and hip replacement procedures, I am now looking to become a productive member of society.

Prior to my surgeries, I was facing the rest of my life in a wheelchair. My body was collapsing on itself which meant other complications were setting in with additional testing and medications as well. I am only in my fifties so all of this was equating to a higher use of my insurance. The amount of dollars that would’ve had to been invested in my health care to the end of life would’ve been much more astronomical than the initial outlay to have my back, neck and leg fixed permanently with the proper minimally invasive procedures.
I am off all medication now, with physical therapy still necessary, but I’ll be looking for work to be a contributing member of my community, instead of being a high-liability to the insurance company.
Please reconsider you stance on stricter guidelines for the minimally disruptive spine procedures. Many more people can benefit greatly from these medically necessary spinal fusion procedures and, in turn, become an asset of wellness, instead of a liability for the insurance companies.

Kathleen Mosko
Henderson, NV

Dear Sir/Madam:

I recently heard that the regional Medicare Administrative Contractor (MAC) for Florida, First Coast Service Options is the latest to propose a policy with stricter guidelines for insurance coverage of minimally disruptive spine procedures. Unfortunately, this decision will deny insurance coverage for many patients who may suffer from conditions similar to mine and who are in desperate need of a long term solution for their chronic back/leg pain.  The following is a brief summary of my story in recovering from three back surgeries, the latest a minimally invasive XLIF procedure in November 2008:

Brad’s (that’s me, William Brad Bennett) back pain began while he was running track in junior high school and he was diagnosed with congenital stenosis and degenerative disc disease.  Many years – and two back surgeries – later, the pain was worse than ever. Brad’s competitive spirit was finally beaten out by the pain, forcing him to make some humbling changes in his life just to get by: taking powerful pain medications, leaning against a wall or sitting whenever possible, and eventually using a motorized scooter just to stay mobile.
Not wanting to let the pain win and determined to get his life back, Brad decided that enough was enough!
A school nurse colleague of Brad’s wife who was familiar with Brad’s situation told him, “There’s only one doctor in Las Vegas I trust my back to.” Heeding her recommendation, Brad met with the physician from the University Medical Center, who recommended that he undergo a new type of minimally-disruptive spinal surgery. Called XLIF®, the procedure would allow the surgeon to enter Brad’s body through an incision in his side, avoiding the major muscles, organs and blood vessels that can be disturbed during traditional back surgery. Physicians would monitor real-time data of Brad’s local nerves to ensure they were not harmed or irritated during the surgery.

Brad was walking with assistance the same evening of his surgery and returned home after two days. Five weeks later he was pursuing recovery in physical therapy like a young athlete again – walking every day and doing his stretching and strengthening exercises, including pool therapy.  Brad and his wife, Jeanette, celebrated his one-year surgery anniversary by completing a six-mile hike in Southern Utah. He is now enjoying cross country skiing and snowmobiling and says that the improvement in his quality of life is “beyond explanation.” In April 2010, Brad will participate (walk) in the Carlsbad 5000, a 5k in southern California that draws novice and elite runners from around the globe.  
Brad now regularly walks more than three miles a day and completes hikes of more than six miles.  He has completed at least five 5K walks and is thoroughly enjoying his “new” life.  What a blessing the XLIF surgery has been in his life, as well as his immediate family, which includes soon-to-be 10 grandchildren.
William Brad Bennett