Brian Newman planned to take his wife to Niagara Falls for their fifth anniversary this April.
That was before his back gave out, leaving the Westminster couple unable to plan anything while they wait in limbo for his health insurance to approve a state-of-the-art surgical procedure to fuse two vertebrae in his spine.
“We can?t plan trips, in case we get the approval,” Charlene Newman said.
His insurance company, United Health Care (UHC), denied coverage of the procedure on the day Newman reported for surgery.
“This procedure is considered experimental” a UHC letter to his surgeon stated.
His doctor disagrees.
Paul Asdourian, a board-certified spine surgeon with Greater Chesapeake Orthopaedic Associates, wants to use a patented protein that spurs bone growth rather than an older technique that requires scraping fragments of bone from Newman?s hip to fill the gap.
“Clearly it?s not experimental. Data have shown it to be clearly more effective,” Asdourian said. “Prior to now, I?ve never been faced with a situation where an insurance company is telling me which operation I can do. I believe they?re truly practicing medicine, and if they are going to practice medicine they should be fully liable for any complications.”
A spokesman for United Health Care did not return multiple phone calls for comment after receiving written permission from Brian Newman to discuss his condition.
Asdourian refused to operate using the older technique because of the increased risks of complications. “Whenever you take bone from a hip, you raise the risk of infectious complications,” he said.
The compound ? a synthetic protein called INFUSE ? is FDA-approved for this kind of surgery and covered by Medicare.
An article in the journal Spine found higher rates of success after two years from the date of surgery using INFUSE, and an average of 55 fewer missed work days. None of the INFUSE recipients experienced complications in this trial, while eight of those receiving the older bone-harvesting procedure suffered “adverse events.”
Newman says he?ll wait, hoping UHC changes its decision and thinking about 55 fewer days out of work. “If I?m out of work, I don?t get paid, so right there I?m gonna lose a lot of money,” he said.
