KNEE ARTHRITIS - Autologous chondrocyte implantation (A.C.I.) :

Insurance cover for ACT - - Posted by ergomaniac (ergomaniac), 19 April 2003

Can anyone tell me what the score is regarding insurance cover in the UK for ACT on the patella? I've heard that at present private health insurance companies in the UK aren't covering this surgery. Has anyone on the forum tried to make a claim or knows what the current situation is?

Thanks Ergo.  
Posted by Iona_-Uk (Iona), 19 April 2003

Hi ergo

I know my policy with BUPA won't cover it, it's in a seperate bit of the policy documentation you get when you want to make a claim for anything orthpaedic, it doesn't tell you on the actual policy.

I must strss I only have a basic policy & it may be more expensive policys will cover you but it's best to check the wording with the company before taking out any policy.

Iona
Posted by ergomaniac (ergomaniac), 19 April 2003

Oh great! I'm with BUPA as well  

Did you try to claim for ACT Iona? If so was that recently as I know this area of treatment is moving rapidly so perhaps things might have changed. Were you offered ACT then and had to turn it down because it wasn't covered?

Sorry to hassle you with questions but the OS I'm seeing is part of the UK articular cartilage repair group and there's a possibility I may be suitable for ACT but  I don't want to get my hopes up if BUPA won't cover it.

I wonder how much it costs. I tell you I'm so low   with my knee at the moment that I'd use my last penny of money if there was a reasonable chance that a particular treatment could give me an extra 10 years of relatively problem free knee.

Thanks Iona, Ergo
Posted by Iona_-Uk (Iona), 19 April 2003

Hi Ergo

No I wasn't claiming for ACT, I was trying to claim for PT & they sent me a list of all conditions & ther related conditions that they would not cover for and ACT was one of them BUT that was on my very basic policy.

I only pay £14 per month I have an employers contrubution of £2.71 and that's got a £250 excess and it is really basic, I've not tried to claim anything again because of the wording.

If you give the membership number a call, have your policy soucments ready and ask they may be able to see if you wuld have a claim or not depending on your policy limitations.

Give them a call, not sure if they are open today, discuss the situation with the advisor & they should be able to tell you outright.

I can certainly sympathise with your situation, I'm feeling like that too.

Iona x
Posted by ergomaniac (ergomaniac), 19 April 2003

Hi Iona

Thanks for the info. I'll give them a call and see what the score is on Tuesday when the office is open.

Take care

Ergo
Posted by ergomaniac (ergomaniac), 25 April 2003

Hi all

Just to keep you updated. I had a really good consultation with my new OS this week and it looks as though I am being referred for ACI but I've still got to get around the BUPA hurdle. I do have the option of a referral on to another centre that I can probably get covered under BUPA but now that I've found a good OS that I can trust I want to stick with him plus the rehab protocols are different and all sorts.

I'm up for a fight on this one though and I'm collecting as much ammunition as possible to 'make my case' to BUPA next week. So watch this space for updates!

What is the next step if a private health insurance company refuse to cover treatment? Is there an appeals procedure or something? Anyone else had to go down that route and won?

Ergo
Posted by Allan (Allan), 7 July 2003

hi ergo
just to let you know i had my ACI fully covered under BUPA at New Hall Hospital in Salisbury under Mr Gurd Shergill, so they do cover it I'm on band C with BUPA on a family scheme hope you get it sorted.
Any further questions feel free to ask
Also now have a visible knee but no strength still it looks good

Allan
Posted by ergomaniac (ergomaniac), 7 July 2003

Hi Allan

I'm on band C bupa scheme as well but corporate not family. In May Bupa said they wouldn't cover it as they had already paid for the number of places on the clinical trial that they had committed to and at present ACI is only available on clinical trial therefore no-go. I got it through on a technical loop hole! I believe that there has been some recent neogtiations on this front so that anyone on similar BUPA cover should now be able to get ACI.

Has anyone else in the UK been turned down under private health insurance for ACI recently?

Ergo  

Posted by Rich_UK (Rich_UK), 15 March 2004

Just joining this. good to know that there are other people in the same situation as me. I'm with norwich Union Healthcare and they won't cover it because it has not been approved by N.I.C.E.

Cost of the two procedures is around £15,000 but thn you will need to add the physio and rehab costs.

looks as though I will hav eto go withthe mosaicplasty option for my surgery but the stats are not as good as for ACI

this is scheduled for april 7 so time is running out for me

R
Posted by Rich_UK (Rich_UK), 15 March 2004

sorry forgot to mention that even if you speak to BUPA they will not cover you as you have a pre existing condtion , as with all PMI's these are exempt
R
Posted by Rich_UK (Rich_UK), 15 March 2004

sorry forgot to mention that even if you speak to BUPA they will not cover you as you have a pre existing condtion , as with all PMI's these are exempt
R

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