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Author Topic: BCBS and paying/not paying for surgeries  (Read 1273 times)

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Offline michelel

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BCBS and paying/not paying for surgeries
« on: February 01, 2009, 01:04:07 AM »
Hey yall, I am going to sports med OS, at the University after a failed MFX done by my regular OS.  He told me my osteochondral impaction fx of the MFC is 2cm X .5cm and that I need an OATS or ACI.  So I've been doing research online and decided to look up by BCBS insurance website to see what if anything they would pay for.  I was really shocked, they will pay for ACI, but will not pay for OATS they say its investigational.  Also they will not pay for a CPM machine they say its NOT medically neccasary.  What the heck??  Seems to me they would pay for OATS before the ACI , I guess thats what I get for thinking.  Anyway my appt.  is March 3 and I dont know what I'll do if she advises OATS.  I sure can afford to pay for it out of pocket.  And I HAVE to have something done because the pain is severe im on narcotics every 6 hours, cant go up and down stairs, can hardly get out of chairs or the couch.  My quality of life is suffering badly. And what will I do with no CPM machine??? please any advice is so welcomed, thanks fellow kneegeeks, I know I can count on yall.
Michele ???
Right Knee:  1983 meniscal tear scope debridment &lateral release. 1991, 1997, 2001
2003 scope meniscal tears. 
8-08 MFX MFC lesion FAILED.
 4-09 Went in for OATS-not a canidate.
 6-09 Uni Right MFC.

Offline embillma

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Re: BCBS and paying/not paying for surgeries
« Reply #1 on: June 13, 2009, 05:12:09 AM »
Interesting that they would pay for ACI but not pay for a CPM which is extremely important in the healing process.  I had ACI surgery after the OS had multiple discussions with my insurance company explaining that it was necessary.  I was very lucky to have an OS that was willing to fight with my insurance company for me.  The CPM was a rental unit that I had for 3-4 weeks.  Do you need a CPM for PKR?
1998 ACL reconstruction
2005 Microfracturing
2006 ACI
2007 Overgrowth of ACI -trimmed down excess cartilage

Offline michelel

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Re: BCBS and paying/not paying for surgeries
« Reply #2 on: June 13, 2009, 05:58:29 PM »
Hey interestingly enough no i wont need one after the uni/pkr.  The nurse told me that I will be up the night of my surgery and often.I dont know if youve read any of my other post, but my surgery date in Wednesday!  I am quite excited, at the prospect of being able to live a normal life again, however I am totally scared of the post op pain, I will have some sort of nerve block that numbs the whole leg, and po andIV meds as needed. Its a 1or 2 night stay in the hospital, depending on how well you are tolerating the pain, and how well youre able to move around.  Well theres an update, thanks for your reply.

PEACE & LOVE
Michele
Right Knee:  1983 meniscal tear scope debridment &lateral release. 1991, 1997, 2001
2003 scope meniscal tears. 
8-08 MFX MFC lesion FAILED.
 4-09 Went in for OATS-not a canidate.
 6-09 Uni Right MFC.