KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: Cinammo on February 10, 2006, 01:11:15 PM

Title: Submitted the Appeal on the OATS procedure yesterday
Post by: Cinammo on February 10, 2006, 01:11:15 PM
Dr. Cole's office could not submit the appeal.  Our insurance company said it would be a conflict of interest.  So they just wrote the letter for me like it was comming from me and sent it too me along with a few articles.  My son wrote a letter also which in and of itself was pretty sad.  He talked about the pain he has and how it has limited him in everything he has done.  He said something in his letter that I thought was real good.  He said "you allowed me to go to this doctor and now he wants to fix my problem but you won't let him, maybe you should be doctor cole instead".  Then he said" if you won't let me have this surgery then you need to tell us how to fix my knee".  i hope something in what I sent our insurance changes their decison.  I will keep you updated.

Title: Re: Submitted the Appeal on the OATS procedure yesterday
Post by: brattkids on February 11, 2006, 01:45:58 PM
Best of luck to you!!!!!!!
 :) :) :) :)

Paulette
Title: Re: Submitted the Appeal on the OATS procedure yesterday
Post by: brattkids on March 23, 2006, 12:33:01 PM
Just wondering if you were having any luck with the insurance company???

Paulette
Title: Re: Submitted the Appeal on the OATS procedure yesterday
Post by: Cinammo on March 27, 2006, 12:34:11 PM
Thanks for asking.  It will be 45 days today that the appeal has been at the insurance company.  They have 60 days to give a decision.  I will let you know as soon as I know.  Here's hoping and praying that it will be a positive decision.
Title: Re: Submitted the Appeal on the OATS procedure yesterday
Post by: Beauzer on March 28, 2006, 03:43:07 PM
My insurance company decided not to pay for my OATS after I had it.  I was pre-certified and everything.  Eventually they did pay for everything but the surgeons' fees (which made me feel like a real jerk, since I work with the surgeons and see them everyday, and being nice guys, they didn't collect the $7000 I couldn't pay)

It really doesn't make sense, does it?  They would rather pay for young people to have joint replacement, than for an "experimental" procedure, which OATS clearly isn't, as it's been around for quite awhile and is an accepted procedure in the orthopedic community.

If they won't pay for it, I'd talk to your doctor about reduced charges and stuff like that.  They may be willing to work with you if they truly feel that OATS is the right way to go.

Good luck,
Danielle