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Author Topic: insurance issues ?  (Read 1079 times)

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Offline a2n

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insurance issues ?
« on: August 23, 2005, 02:08:07 PM »
Does anyone have any experience with insurance companies refusing to cover the cost of acl surgery on patients over 50 ?
A friend of mine said his doctor told him that was now standard proceedure due to the cost of the procedure.   I live in Iowa, in the US.  Also wondering just what the out of pocket cost would be, probably a lot.
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline amy1

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Re: insurance issues ?
« Reply #1 on: August 23, 2005, 04:06:52 PM »
I have never heard of that.
6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week

Offline a2n

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Re: insurance issues ?
« Reply #2 on: August 23, 2005, 04:28:41 PM »
I hadn't either, but when my friend told me this last night, it caused me to wonder.
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline raquetball1

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Re: insurance issues ?
« Reply #3 on: August 23, 2005, 05:26:09 PM »
Hi ann,

I was two months shy of 51 and Aetna paid in full (negotiated price) for surgery and all that went with it(anasthesia, immobilizer, crutches, two months PT).  If insurance companies stop paying for acl recon on fifty and over, I'd think a class action suit of some sort is needed.  Middle-aged adults are more active than ever and any pivot sport will require surgery unless one wants to brace for it which, in some cases like mine, is impossible since I have to brace an unrepaired acl knee already. The "original" cost for the surgery at an out-patient surgical facility was something over five thousand dollars, if I recall correctly.  The Aetna negatiated price was less than two thousand dollars.   

Basically, insurance companies can either pay NOW for the acl recon, or pay a sh*tload later for all the damage that the torn acl will cause in your knee as you age even over the incredibly old age of 50 (hope the sarcasm is dripping here).  At nine months post-op, I'd like to invite any representative of these insurance companies refusing to pay for surgery for pt's. over 50 to join me for a game of racquetball in Ohio at any time they'd like to step on the court with me. (Interesting note:  rball is an intense pivot/plant speed sport and most good recreatioinal players are 45 years old and over.) 
autopatellar acl recon Nov. 2004 at age 51

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Offline a2n

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Re: insurance issues ?
« Reply #4 on: August 23, 2005, 06:12:16 PM »
Thanks Raquetball1.   I agree with you completely! 
I am going to see my OP and persue the reconstruction surgery with high hopes.
Ann
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline a2n

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Re: insurance issues ?
« Reply #5 on: August 24, 2005, 01:40:15 AM »
I just got back from a meeting with my OP, and as it turns out my insurance company will cover my acl surgery, and everyhing else.   Woo Hoo!   I'm scheduled for surgery the 12th of Sept.   Also walking with a cane, rather than crutches as of tonight.
I am feeling good about everything right now.
Ann
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline raquetball1

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Re: insurance issues ?
« Reply #6 on: August 24, 2005, 03:53:27 PM »
Most excellent to hear, Ann!!   Best of luck on your surgery. 
autopatellar acl recon Nov. 2004 at age 51

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Offline brattkids

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Re: insurance issues ?
« Reply #7 on: August 24, 2005, 06:01:47 PM »
Ann,

That is great news!!! So good to hear some good news once in a while!!

Best of luck on your surgery!!

Paulette
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop