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Old 03-30-2009, 10:59 AM   #1
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Os Trigonum Excision

Hi,

I injured my ankle a few months ago playing soccer. I thought it was just an ankle sprain. The pain lingered when I ran or jumped, so I finally had it examined. My doctor believes my Os Trigonum is pressing against the tendon and that is causing my pain. I've been in a walking boot for 3 weeks and I had a cortisone shot 10 days ago. I don't have any reduction in pain. My doctor believes I need surgery to remove the bone.

My problem is that I went to an out of network doctor. I originally believed that it was nothing and my doc would merely tell me I need physical therapy. I was fine with the out of network cost for something like that. I found out today that the surgery will cost me at least $1200. I've tried to contact my insurer (United Healthcare) to find out what the procedure code would cost in-network. I haven't had any success.

Does anyone know how I can find this out or will I need to consult an in-network doctor and then find out how much he/she will charge?

I hate price shopping for doctors, but $1200 (not including the anesthesia and hospital charges) is more than I'd like to pay right now. Obviously, I should've stayed in-network from the beginning and I'm kicking myself for it.

Any suggestions or advice would be greatly appreciated.

Thanks.

 
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Old 03-30-2009, 01:09 PM   #2
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Re: Os Trigonum Excision

Look up the details of your plan. You should have a copy of it lying around, or maybe your employer's human resource department can give you one.

See what the "outpatient surgery" benefit is. It might be covered in full, or it might be 90% of the cost, or you might have a fixed copay like $100.

 
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Old 03-30-2009, 01:22 PM   #3
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Re: Os Trigonum Excision

I have a 80/20 plan for in-network surgery. I would be responsible for 20%. United Healthcare can't tell me how much I will be paying 20% of.

Right now, I think the only way I'll get an answer is the get a second opinion and get a cost estimate from the in-network office. I was just hoping I could find this out without waiting for a second doctor.

 
Old 03-30-2009, 07:58 PM   #4
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Re: Os Trigonum Excision

Probably similar to what the other doctor wanted, maybe somewhat more. You do need to ask them to find out.

 
Old 03-31-2009, 08:05 AM   #5
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Re: Os Trigonum Excision

The in network doctor can bill whatever he wants but he has signed a contract with united healthcare and must accept whatever their approved charges are. If you could find out the procedure code then United Healthcare can tell you what that charge is. I as a doctor don't even know what these amounts are for the most part because every insurance company is different and they are constantly being decreased and it just isn't worth it to try to keep up with them. Now the out of network doctor can charge whatever he wants. Could be a nice guy and charge you a lesser amount or may actually charge more than what your insurance would approve and you will be responsible for that difference. Unfortunately healthcare has evolved to where you do have to make decisions on cost and unfortunately the insurance companies really don't want you to know how little they pay anymore and make it very difficult. I just saw a guy yesterday with a 50 dollar copay and his charge was only 52 dollars that the insurance company approves. Aren't insurance companies great. They take your money every month and a lot of times never have to pay anything out.

 
Old 03-31-2009, 09:30 AM   #6
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Re: Os Trigonum Excision

Hi,

Thanks for your reply.

I have the procedure code (27680) and I spent an hour on the phone yesterday with United. They couldn't give me an answer. I spoke to the customer service person and he sent me to another person and she spent an hour trying to get an answer. She was going to transfer me back, but I had to get back to work.

The person at my out of network doctor's office said they would only charge for one code, instead of two codes, to cut down the cost. Sadly, I still need them to reduce the cost or I cannot have the surgery.

 
Old 03-31-2009, 10:10 AM   #7
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Re: Os Trigonum Excision

Ah, you're having one of those conversations with them.

All health insurance companies do that. My personal belief is that it's a way of making sure you really want the surgery bad enough.

 
Old 03-31-2009, 12:14 PM   #8
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Re: Os Trigonum Excision

You're probably right because right now I'm questioning whether I really want the surgery.

I started looking at doctors in network. One guy is a podiatrist who specializes in surgery of the foot and ankle. The other guy is an orthopaedist who specializes in the foot and ankle. Any thoughts on a podiatrist vs. orthopaedist? I know it's been discussed here. I'm leaning towards the orthopaedist, but I can't say I have a really good reason other than the fact that the last podiatrist I saw was pretty bad.

 
Old 03-31-2009, 01:44 PM   #9
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Re: Os Trigonum Excision

A podiatrist who is a podiatric surgeon is ok.

I would really make the decision based on which of them does this type of procedure more often.

 
Old 04-01-2009, 11:35 AM   #10
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Re: Os Trigonum Excision

Is there a way to find out online how often they do the procedure? I called both of the offices and their staff sounded genuinely surprised by the question. They said they would get back to me.

I called the out of network doc's office to see if they can reduce the price. The woman responsible for these matters is out to lunch, so I have to wait.

 
Old 04-09-2009, 09:03 AM   #11
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Re: Os Trigonum Excision

Has anyone had an Os Trigonum excision done arthroscopically? I've read about it a little online, but my doctor didn't mention this option.

If I go through with my current doc, I was told I would be in a cast for two weeks, a boot for 4 weeks (with PT) and should be able to move around okay in 6 weeks, but probably wouldn't be 100% until about 3 months. I want to be able to run as soon as possible, so the 3 months is a difficult idea for me.

Please let me know if anyone has had it done arthroscopically and what the recovery time is like.

Thanks.

 
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