Insurance coverage for prp treatments

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Hi everyone:
I consulted with OS 9/14/09 regarding being a candidate for prp treatments. Dr. said I might be if the MRI reveal tendon damage. I was so hopeful that I might have an end to this nightmare called tendonitis until his P.A. called me today.The M.D. is wanting to do bilateral MRI (both knees are damaged), ultrasound, and then inject. I spoke to my insurance provider regarding payment for this procedure. Being that this is considered an experimental procedure the insurance provider happily said HELL NO!!!!!!!! I kind of knew this before calling but I had to give it a shot. My question out there to all those fortunate ones that have had this done. HOW DID YOU GET THIS COVERED!!!!!!!!!! I would really appreciate a response. Thanks ctot

ctot93, i also am a candidate for prp and my insurance carrier will not cover it either. i was told by my surgeon that they, unfortunately, have never had a patient be covered for this treatment- and it is a practice at the hospital for special surgery in nyc. my parents and i have discussed this, and since this seems to be one of my only options we are going to do it, even though the price is very steep. afterall, i am only 20 years old and i want to be able to function pain free, at least for a little while...good luck to you!!

Hi,

Thanks so much for replying to my message. I'm sorry that you are having trouble with your knee and it definitely sucks at your age. How did you injure it and how bad is the pain. I can work but any type of cycling or running is out. Could you please let me know who your doc is and if not to personal the cost of the procedure. I have been consideriing calling universities to see if there are any clinical trials going on in the midwest. I did speak with Dr. Mirshra assistant in Ca but because of logistics I was not a candidate. Please let me know how things work out for you Thanks again for responding.

ctot93

Hi,

We actually do not know exactly how I injured my knee. I had been complaining of pain since I was about 7 years old and doctors kept telling my parents I was fine, and to put me in sports and what not. It wasn't until I was 16 that they realized I really was in pain, so I have exploratory surgery to cleanup a lot of cartilage damage, that did nothing for my pain, but the OS said that was all he could do. At that point the pain was so bad that I had to quit sports all together, but since I was told there was nothing I could do, I believed them. Then, when I was 18 it got worse then ever and I got a new OS who preformed a TTT, LR, and MI. Unfortunately that did not work either and I began looking for a new OS. My search brought me to a specialist at the Hospital for Special Surgery in NYC. Her name is Dr. Beth Shubin Stein and I personally think she is the best. About 8 months ago she preformed an MPFL reconstruction, and once again cleaned up cartilage damage, which is practically bone on bone by now. Prior to seeing her, my previous OS had me try 5 rounds of the supartz injections, which I did not respond too. After the MPFL reconstruction, I developed severe patellar tendonitis. I have been in rigorous physical therapy for a year and a half now, and am still is severe pain. Pain pills don't work, and almost everything I do causes some sort of pain. I am now in the process of getting clearance for a different set of natural lubricant injections then supartz called synvisc, hopefully I will get a response from these, as well as the prp. My OS does not perform this procedure, but a colleague of hers does, Dr. Jennifer Solomon. I was told that since she does this treatment in her own office there would be no radiologist fees, or hospital fees, so the cost would be somewhere around $1500, which is painful to even think about. How did you injure your knee? Hope I have been able to help a little. Good Luck!

Alyssa

Hi Alyssa,

Have you considered stem cell regeneration for deteriorating cartilage. Dr. Brian Cole at Rush Hospital in Chicago is a leading researcher in this area. He might be someone to consider concerning your cartilage problem. I wish I could say my knee pain was due to anything other than stupidity but I can't. I simply overtrained for triatholon and refused to listen to my knees when they decided to go on strike. Long story short, developed severe bilateral tendonits, unable to ambulate for 2 months, and then rehabbed for 6 months. Went to Dr. Cole he scoped knee, did chondral pouch, more rehab but not much change in pain when exercising. He did say that knee cartilage was healthy(which was a relief since another OS told me I was developing arthritis). I found out about PRP treatments on statelite radio and started investigating outcomes. Spoke with P.T. who has seen PRP treatments in shoulders, and said results for chronic tendonitis have been unbelieveable. I can't imagine the pain your going through but if its any consulation the medical technology using stem cells is looking very promising for people with severe knee problems. Please keep me updated on your situation, and hang in there. Take Care otct93

Hi!

Thanks for mentioning the stem cell regeneration, I am definetly going to look into it, and see if it is something I could benefit from. I am sorry to hear about your knee, but I hope you get some relief soon. I have scheduled my synvisc injections and also my PRP treatment. I am beginning the synvisc on 11/24 and the PRP is scheduled for 12/4. I'm excited, but very anxious. I am very hopeful that this will work, and will relieve some of my pain, because I can honestly feel it getting worse all the time. I will let you know how it all works out. Take Care!

Alyssa