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Author Topic: Delicate $ question  (Read 1622 times)

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Offline RLE

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Delicate $ question
« on: October 22, 2011, 02:31:20 PM »
I've read on here how people travel to see other physicians. I'm wondering how they pay? My insurance already costs a fortune ($876. per month for one person plus 20% of the bill etc) and they won't pay for out of state doctors. My OS wouldn't ok a wheelchair so I'm paying for it-used it around the house at first and now at the computer. I've been struggling in PT so I'm going to rent a walker (I use crutches) to practice walking like I do in PT and that will cost. The CPM has saved my knee-literally since I've struggled with stiffness even after the manipulation and I will pay for it myself ($25/day) after next week if I'm still stiff. There have been so many extra things that I've had to pay for that I couldn't had a family member not stepped in.
My insurance is a PPO so I'm lucky I can see any doctor I want but not out of state.
I've had many, many,many health problems in the last 12 years but not one (including surgeries) lasted this long or cost this much.
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T

Offline KW

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Re: Delicate $ question
« Reply #1 on: October 22, 2011, 02:49:45 PM »
A tip for the Wheelchair and Walker....Check local thrift stores.  A lot of people (like myself) end up with a collection of DME (durable medical equipment) and donate it to Thrift Stores.  You can pick it up really cheap and most of the time it is in near perfect condition.  This would be much cheaper then renting.
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline elliottl73

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Re: Delicate $ question
« Reply #2 on: October 22, 2011, 03:04:35 PM »
Wow I guess I should be more thankful than I am for my coverage.  I am sure anything my DR orders will be covered.  You could also check with the Red Cross for walkers and wheel chairs.  I have heard of people getting help from them before.
Best of Luck
Laurie :)
9/2010 fell broke nose and injured L knee
10/2010 MRI  negetive
1/21/2011 diagnostic arhtroscopy woke up with MFX
8/11/2011 new MRI showed failed MFX
9/1/2011 Biopsy for carticel
11/1/2011 ACI
5/31/12 scope and microfracture again 1/2 ACI failed
9/2/12 Scheduled OATS,Osteotomy
 
Laurie

Offline dm

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Re: Delicate $ question
« Reply #3 on: October 22, 2011, 05:26:20 PM »
I got my 4 wheel walker with a seat and handbrakes (an item that costs over $200) for free courtesy of a Freecycle member that no longer needed it and gave it to me. I used it for 2 months when I was unable to walk after my last surgery, and my wheelchair wouldn't fit down the hall in my house easily. I'd sit on the seat and scoot around instead, or put my meal on the seat and stand and hop to get to where I could eat it.

Freecycle is a wonderful organization here in the US that keeps all kinds of useful items out of landfills, and they often pass DME items between members. you can go to freecycle.org and find a group in your area of the country. The criteria for passing along any kind of item - be it household goods, clothing, computer items, whatever, is that it be FREE - the person giving it can't charge for it. I've gotten items to fix my house, cleaned out cabinets, given away clothes I've outgrown as I lost weight, asked for items I needed like the walker, etc through this group.

You may not get what you ask for, someone may not have one they can give, but may be able to offer a tip of where you can find one inexpensively in your area, I've done that for people too, to give them options to expensive and unaffordable new items.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline LKnees

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Re: Delicate $ question
« Reply #4 on: October 22, 2011, 11:50:45 PM »
I thought my insurance was bad but at least I have out of network benefits. I do have to pay 20% out of pocket though which really adds up. I've never had so many medical bills. I had to ask my family and use up my savings. I guess it'll be worth it if I can walk normally.

Offline RLE

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Re: Delicate $ question
« Reply #5 on: October 23, 2011, 03:21:45 AM »
Thank you for the suggestions. I also found some cheap equipment on CL. Just tired at the thought of getting someone to drive me the hour each way for each item but in the end will be cheaper than renting.
Wondering how people afford out of state surgeries and consultations?
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T

Offline elliottl73

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Re: Delicate $ question
« Reply #6 on: October 23, 2011, 01:58:10 PM »
I am not sure about that.  I have never done that.  If you are in LA have you checked UCLA or another university hospital? I get current or cutting edge care at UNC.  All I need is my pcm to reffer and get approval I have never been denied care yet. Lucky for me I pay a $12.00 copay and that is it.

Good Luck,
Laurie :)
9/2010 fell broke nose and injured L knee
10/2010 MRI  negetive
1/21/2011 diagnostic arhtroscopy woke up with MFX
8/11/2011 new MRI showed failed MFX
9/1/2011 Biopsy for carticel
11/1/2011 ACI
5/31/12 scope and microfracture again 1/2 ACI failed
9/2/12 Scheduled OATS,Osteotomy
 
Laurie

Offline Driden

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Re: Delicate $ question
« Reply #7 on: October 23, 2011, 07:53:23 PM »
This is an excellent topic for discussion. I will share my experience. The OS whom everyone in my state says is the "best" made my knee much worse with a lateral release. He insisted that, according to Merchant xray view and MRI, it was tracking better than before. I got a second opinion from the chair of the orthopedics/sports medicine department at my state's flagship teaching hospital. He likewise said that the patella was tracking better according to xray and that I probably had nerve damage or RSD.  He said more surgery would just make things worse.

But 2 non-Ortho docs said I clearly did not have RSD. And two EMG/NC studies were negative for nerve damage. I knew I had to leave this state for an answer. The problem was that, according my insurance plan's physician directory, all in-network doctors are only inside my state. Under an example in my insurance manual, an out-of-network procedure and 3-day hospital stay costs tens of thousands of dollars. I do not have that kind of money.

I called my insurance plan in distress. It turns out that there is something called "wrapper coverage" where insurance plan has an arrangement to tap into a broader network. In my case, under the "bcbs blue network" I can go to anybody in the country who takes blue cross and it will be deemed "in network" just as if they were local. All of the docs whom I saw or thought about seeing (and their hospitals) take my insurance as in network. This is not advertised and I never would have known but for a phone call and demand to speak to somebody more knowledgeable than the initial person who spoke to me.

In the alternative, some plans have an appeal process for in-network payment of procedures not done locally. A consultation and perhaps special imaging out of state may be necessary to present this appeal--which may be expensive out of network bit not totally out of reach perhaps.

In my case, I ended up needing LPFLr (reversal of lateral release) combined with tibia derotation and various other procedures. The number of OSs in the US who can diagnose and fix  ALL of my problems in one operation is somewhere between 3 and 6, I imagine. And they certainly do not live in my state. Thank God for the wrapper coverage.  I say that every day.

If there is not out of state coverage and you need an out-of-state procedure plus hospitalization, things are more tricky. Some providers offer large discounts for upfront pre-payment in full. Others will let you negotiate a payment plan.

Offline RLE

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Re: Delicate $ question
« Reply #8 on: October 23, 2011, 08:17:05 PM »
Laurie,
I have many years of attempts of treatments in various depts at UCLA. IMO they are horrible. Occasionally they used to be cutting edge. For example, in 1979 my mother had a detached retina and had surgery and then laser at Jules Stein. Dr. Yoshizumi was one of the first in the world to do the surgery but other than that I have an unbelievable collection of unbelievable stories that would make you laugh (and cry) at the experiences I've had there. I trust Cedars far more and if you pay attention to the media you'll notice that really wealthy people and those with choices go to Cedars. I'm really angry at UCLA in case you can't tell.  >:(

Driden, thanks for the input. I'll call Blue Shield and ask but since my insurance is from the state of California because I couldn't get insured elsewhere (yeah, and it still costs me $876. per month) I'm not sure what luck I'll have. I'm so fed up with doctors and the health care system. Not the system but the lack of access when we pay so much money. I'm not sure how to approach it since it isn't a case of a reversal but rather avoiding a lateral release. I will use the terms you gave me. Wish me luck!
I hope you are all doing well and pain free.

Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T

Offline Driden

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Re: Delicate $ question
« Reply #9 on: October 23, 2011, 08:58:39 PM »
On the bottom right corner of my insurance card, it mentions the "BlueCard access program" and instructs out-of-state providers to bill the BCBS in their home state (it will eventually get passed through to you plan). You might look for the BlueCard magic word and mention it when you call.

Offline elliottl73

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Re: Delicate $ question
« Reply #10 on: October 24, 2011, 12:10:52 AM »
Wow I assumed UCLA would be "the s**t' guess not.  I really like my DR at UNC.  We lived in CA for 5 years my husband is retired military. WHat about UCSD or other state schools? I am from WA originally and have had great success with UW.
I am sorry to hear all the trouble you have had  Hope it all works out for you


Laurie :)
9/2010 fell broke nose and injured L knee
10/2010 MRI  negetive
1/21/2011 diagnostic arhtroscopy woke up with MFX
8/11/2011 new MRI showed failed MFX
9/1/2011 Biopsy for carticel
11/1/2011 ACI
5/31/12 scope and microfracture again 1/2 ACI failed
9/2/12 Scheduled OATS,Osteotomy
 
Laurie

Offline RLE

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Re: Delicate $ question
« Reply #11 on: October 25, 2011, 03:12:04 AM »
Laurie, I've found it depends upon the surgeon. Had amazing independent doctors and bad university professor surgeons. The best doctors have mostly been other patient referrals. I'm glad you were lucky. I'm hoping my luck will turn as well.  :)

Driden, can't thank you enough. You literally saved me. I called my ins. company and I can see and be treated by any doctor in the country in my network. I guess that $50,000. plus I spent over the years on insurance and copays and 20% etc will finally be of some use to me. I'm so happy.
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T

Offline elliottl73

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Re: Delicate $ question
« Reply #12 on: October 25, 2011, 01:37:09 PM »
WOW that's great so happy for you.  Do you have anyone in mind? ;D
9/2010 fell broke nose and injured L knee
10/2010 MRI  negetive
1/21/2011 diagnostic arhtroscopy woke up with MFX
8/11/2011 new MRI showed failed MFX
9/1/2011 Biopsy for carticel
11/1/2011 ACI
5/31/12 scope and microfracture again 1/2 ACI failed
9/2/12 Scheduled OATS,Osteotomy
 
Laurie

Offline RLE

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Re: Delicate $ question
« Reply #13 on: October 26, 2011, 12:30:09 AM »
I'm going to try a doctor I read about on here. He's out of state and booked up as far as surgery but at least I'll know what's going on.
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T