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Author Topic: has anyone heard, sorry nothing we can do for you!  (Read 809 times)

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Offline katie1

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has anyone heard, sorry nothing we can do for you!
« on: August 05, 2008, 08:24:04 PM »
hi all,
  Brief History :I injured my knee approx 18 months ago, and been seeing an OS since then. He has done 2 arthroscopic surgeries on me. The 1st was to fix torn meniscus, ACL damage he cleaned up cartilage  under kneecap, and did a LR.  2nd surgery was for scar tissue removal.  I am still having problems, because i am missing a chunk of cartilage under the knee cap.  He wants to do a 3rd surgery to fix that problem, but insurance co is refusing.  They have sent me to 3 of their Drs, and all of them said the same thing.  "There is nothing that can be done, you have to wait until it gets really bad then have a TKR,  but not until you are 60 years old!  Just start taking pain meds regularly for the pain" 
I am so frustrated has this ever happen to anyone else?  thanks   katie

Offline MartinsGirl

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Re: has anyone heard, sorry nothing we can do for you!
« Reply #1 on: August 05, 2008, 09:02:16 PM »
Hi Katie,

I'm so sorry to hear that.  Could it be that your insurance company has instructed their docs to say that? To prevent them from having to pay more?? I live in Canada, so we have health coverage for everyone (yes we're lucky, but often what that means is that with specialists, you're left waiting for months for an appointment and up to a year for a surgery date).

I've never heard of someone young (I'm assuming you're young since you made it seem like 60 yrs old was a long ways away) being told to just wait until your knee gets really bad and then have a TKR.  Maybe it's just me.  And to suggest you take pain meds regularly?? Did they prescribe something? Or they just expect you to pop Tylenol every day for the next few decades??

I feel bad b/c it seems like you're stuck having to do what the insurance company's docs say.  Otherwise you'll have to pay out-of-pocket, right??

I'm hoping others on here who live in the same country as you (US???) can suggest ways to get around the issue.  It's sickening how some insurance companies can expect someone to just let their knee degenerate before their eyes when there's likely some way to prevent it.  It seems, like many of us on here have encountered, unless you've actually HAD a knee injury and surgery, some people assume that we should and can just "suck it up" and deal with it for the rest of our lives.

Keep us posted. And again, sorry about your situation and that I can't help.

-July '07-soccer injury
- microfracture of the tibial plateau
- arthroscopy in Oct. '07 (remove torn cartilage and repair microfracture)
-developed AF but beat it (avoided surgery)
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Offline TwoBadKneesUSA

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Re: has anyone heard, sorry nothing we can do for you!
« Reply #2 on: August 05, 2008, 09:30:40 PM »
Hi Katie,

Appeal the insurance company decision.  Will they let you see another OS within their plan, not one of "their" docs?  If they do, get another opinion.  Suck it up and wait is really a bad answer.  I have been told the same thing with my kneecap issues.  I am seeing another OS that has done kneecap replacements.  Why in the world would I want to replace what is not broken?  Also I am considered too young for a TKR.  I would push for one, if that was what was warranted.  Quality of life is important.  At some point pills are no longer a real option.  For myself I am at the point where narcotics are the only meds that cut the pain enough for me to do what I need to do.  Who wants to take those forever (or until I reach the "magic" age for a TKR).

It may be your insurance company thinks the procedure the doc wants to use is experimental.  What is the procedure the doc wants to do, if you don't mind saying?  I would see what your next step in the appeal process is and go that route.

Take care.

'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline UK Girl !

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Re: has anyone heard, sorry nothing we can do for you!
« Reply #3 on: August 05, 2008, 10:19:53 PM »
Hi Katie

Could you change your insurance company? I dont know really how it works where you are.

I was told for years that I would have to wait until I was 60 + for a tkr - ( had all cartalidge removed at 18 and total rupture of acl - pre replacements !  - had a tkr at 43 ! and not a moment to soon !  In the years between waiting for the arthritis to totally cripple that knee i had several arthroscopies and debridements.

Good Luck and hope you get to see someone else to sort it out!

1978 - ruptured acl and all cartalidge removed.
several debridements over years
TKR 10TH JULY 2006  Aug 07 patellar maltracking - more physio! Still pain - but so much better !
BIOMET AGC  TKR  (with 10 yr warranty !)