KNEE ARTHRITIS - Bone marrow stimulation :

Well CRAP! - - Posted by NJDan (NJDan), 12 February 2003

Well, went back to see the Ortho again and all is not well.  The Microfracture/Chondroplasty has not worked - it was a gamble at best when he did it in Oct.  He said the hole was too big for oats and the actual area of bone on bone was 5cm long by 3 cm wide and growing.  I have the pics he took at home now and they look pretty gross indeed!  I am now fighting with my insurance to let me see an out of network doc an hour away who specializes in doing Partial Knee replacements with no kneecap...they cautioned me that I may not be covered for everything IF they even approve it!  The standard line they gave is that if there is not someone who can do it in a 45 mile radius then I have to justify why I need to see a specialist..only then will they MAYBE approve a visit to the doc.  Man, this is worse then the actual PKR...I am ready - as I said to my doc, I am not enjoying life having to sit it out everyday - a PKR MAY be the answer, I am not fully sure yet, but he did assure me that the damage inside will grow until it is all bone on bone and I start damaging that!  What to do, what to do!!

Hope all is well in your worlds.

Dan
Posted by muskypike (muskypike), 13 February 2003

Hi Dan,

Sorry to hear your surgery was not a success, what a bummer.  You go through all that hard work to recover and to get told that.  I bet you were so distraught.  Please don't give up!  Fight your insurance company to the end.  Start dealing with a supervisor, you'll have a better chance of getting what you want, and remember to kill them with kindness.  It's so hard to deal with them, I find  it most infuriating.  We think our insurance is going to protect us, and aid in getting well, but really there objective is to save the company money and make a profit.  So much for managed healthcare.

Good luck to you,

Ellen
Posted by Shazinoz (Shazinoz), 13 February 2003

Sorry to hear of your failed surgery Dan,
It sux to thing that all you have been through has basically be for nothing and now to make matters worse you have to fight tootha and nail to get the only treatment which may offer you a chance at a somewhat normal life. You keep at them Dan you fight and fight until they give int and allow you this procedure. You inundate them with letters, phone calls, doctors letters and informaiton until they wagree just to get you off there backs.
You hang in there Dan, and remember this is YOUR LIFE and HEALTH they are playing games with. You are not a number or symptom on a piece of paper, maybe you should go to the insurance comapnies office, find out who is handling your case at sit outside there office day in day out until they realise youa re a person with a life and not a piece of paper with some writing on it, and not a "thing" but a person who only wishes to have a chance at a soemwhat normal life.
You go Guy, you get them.  
Posted by wendy (wendy), 13 February 2003

Dan,

I am sorry to hear things aren't going well. As you know I have had 2 PKR's and now know probably neither of them worked. I have an emergency visit today with the OS. My PT will not see me again until I see him. My knee cap is clunking, as they put it, back into the groove. They think I may have to have my TTT undone. Just what I want is another surgery that may not fix the problem.

If you do see the new OS just really study the PKR. It can help, but there are risks and the results aren't always that great. My first one did great for about 2 months and now is awful.

Best of luck with everything.

Wendy
Posted by Helen_uk (Helen uk), 13 February 2003

Hi Dan sorry your appointment was so bad, I know here if you want to go outside your area sometimes you can but geneally you have to go private It must feel like you are hitting your head against a wall.
Maybe you should bite the bit and ask for a tkr and enjoy the freedom it will give you now life is for living live it now you never know what is around the corner and maybe when it needs re doing they will have advanced enough to give you some ace joint.
I dont know having to decide on surgery is an awfull thing.
Take care mate
H xxx
Posted by lbdeharak (Linda), 13 February 2003

Hi Dan,

Sorry to hear about your knee news. Just a thought, my OS went to bat for me with my insurance company when I needed the ACI. Perhaps your OS will too? They handled everything. All I had to do was sign papers a couple of times.

Good luck!
Linda
Posted by cyndezu (cyndezu), 14 February 2003

Hi Dan,
I must say i'm in agreement and concur.

CRAP... crap crap... crap crap CRAP!



better day's Cindy
Posted by rhea (rhea), 14 February 2003

Hi Dan,
Im so sorry things didn't work out...  I hope you are able to see a good surgeon to get your knee back to an acceptable level of funtioning.  And boy, I hope your insurance company covers it!  I have this little saying that I like to use... An insurance company is like a hospital gown, you only THINK you're covered!

Byes for now,
All the best to you!

(((hugs)))

rhea
Posted by enuff81020 (enuff81020), 15 February 2003

Hi Dan,

All I can say is that you do not want this bone on bone stuff--that is my lot.  My left knee had total bone on bone until the bone started a hole in the other bone.  That is a big, nasty lot of pain.  My other knee is just about totally bone on bone now too--there was a bit of cartilage--about the size of a dime--about a year ago.  It is about gone, something is locking up in my knee and I am waiting until I can get more time off work for the other tkr.

These insurance companies are real pains.  I always have to think about the folks in the doctor's offices who have to deal with them--they must either be insensitive a--'s themselves or the most thick skinned people in the world.  I know that it IS crap when you finally have some kind of a plan after months of suffering and procedures, only to have some peanut counter get in the way.  To heck with the peanut counters...Sylvia
Posted by KM (KM), 15 February 2003

Hey Dan~
Sorry to hear of your troubles...
Good luck with the knee and the *&^%$#@! insurance company!
Take care

Posted by NJDan (NJDan), 15 February 2003

Thanks for all the replies everyone - it helps to know I have a support group here.

My OS is GREAT and he is giving me all the ammo I need to go head to head with the insurance..they did not say they would not pay, just that they may not pay for everything.  I am definelty not in a position to pay for any extra coverage.  The guy my OS wants me to see is a specialist in Knee Replacements and is innovative...he has done them without kneecaps before and my OS does not want to do it as he has never done on with out a kneecap before...

I'll keep you posted as the battle continues..i want to get this done before the baby arrives if at all possible.

dan
Posted by lizl (lizl), 17 February 2003

Dan,

Good luck with the insurance coverage.

Have you contacted your state's insurance oversite board or the state attorney general? I once had trouble with a Veteran's Hospital and treatment they were denying my Dad. After weeks of going round and round and my Dad near death, I called my US Congressman's office; and things started looking up IMMEDIATELY. They called the hospital and started an inquiry. The mere presence of the investigation changed things for us.

I know that you are up to your ears in bureaucracy with the insurance thing, but there might be a government oversite agency that could help out. You could start with your local congressperson's office.

Good luck.

Lizl

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