Banner - Hide this banner





Author Topic: Submitted the Appeal on the OATS procedure yesterday  (Read 1816 times)

0 Members and 1 Guest are viewing this topic.

Offline Cinammo

  • Regular Poster
  • ***
  • Posts: 131
  • Liked: 0
Submitted the Appeal on the OATS procedure yesterday
« 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.

My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline brattkids

  • SuperKNEEgeek
  • *****
  • Posts: 1288
  • Liked: 0
  • here's to a pain free tomorrow!!! Savvy
Re: Submitted the Appeal on the OATS procedure yesterday
« Reply #1 on: February 11, 2006, 01:45:58 PM »
Best of luck to you!!!!!!!
 :) :) :) :)

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

Offline brattkids

  • SuperKNEEgeek
  • *****
  • Posts: 1288
  • Liked: 0
  • here's to a pain free tomorrow!!! Savvy
Re: Submitted the Appeal on the OATS procedure yesterday
« Reply #2 on: March 23, 2006, 12:33:01 PM »
Just wondering if you were having any luck with the insurance company???

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

Offline Cinammo

  • Regular Poster
  • ***
  • Posts: 131
  • Liked: 0
Re: Submitted the Appeal on the OATS procedure yesterday
« Reply #3 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.
My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: Submitted the Appeal on the OATS procedure yesterday
« Reply #4 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
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05