I responded to your other post about the insurance thing. I would seek legal advice for this if the insurance company denies another peer to peer when they didn't give you an actual peer review. Also, your previous dr. was a dipstick by letting this go and not addressing it.
I'll be curious to see how this goes. I'll say a prayer they approve it soon.
Ok - here's a thought for those having insurance problems:
I know this may sound crazy but here it goes:
So my OATS surgery cost $9,000
My hospital stay cost $12,000
My PT was ~ $6,000
My appts/casts/misc cost ~$3,000
So out of pocket my foot would have cost me $30,000 with no insurance.
Margaret's insurance would not pay for the donor bone and that cost here I think $7,000 but the rest was covered.
Kim's insurance wouldn't pay for the surgery itself but the rest of it.
I think her Dr. worked with her to get her bill down to $3,000
Other people have had surgery and then won their insurance cases later on. So worse case scenario would be paying ~$30,000 out of pocket and probably far less with no insurance. If the insurance pays most of the cost but doesn't cover certain procedures you might be paying $5,000 to $10,000. I know that's a lot of money - believe me, people in MT do not make large wages, but it's still do-able to get a functional foot. Now if you were getting a heart transplant for a 1/2 million that wouldn't be possible, but this surgery cost the price of a new car and we're willing to pay that for a hunk of metal. I think we should be willing to go for the cost with our own bodies. What do you guys think? It's sad that the insurance denials make you go there but it's just a thought.
Total cost of my OATS (autograph) was $27,000 of which all was paid except for $3,000 which was listed as my surgeon's cost ... so $24,000 was paid and 8 months later I still see paperwork going back and forth between my doctors office and the insurance co trying to get the $3,000 covered. My doctor's office has yet to come to me for the $3,000 but according to my insurance company they can't if I didn't agree to pay it before the surgery.
I'll keep you posted should I receive a bill for the $3k, but nothing so far.
It makes no sense to me at all how they would pay the $24k and call the remaining $3k 'investigational.' I am thankful they paid what they did but don't understand the logic.
I had the same thing happen. My surgery costs were closer to $50k with various other procedures, week long hospital stay, ER visit, etc. But they covered everything and then denied the $3k or so for the OATS, even after saying they would. My dr. office billed another code after I had the first code they wanted approved. They are still working out details like Kim's are, but the thing is, they did pay for the rest of it. It is kinda weird they pay for the rest of everything and then deny the reason for the surgery. Maybe it is the actually getting the plugs from the knee they aren't paying for just like Margaret's didn't pay for her allograft. Maybe if we showed up with our own allograft our took our own plug out (not that that is possible, but you kwim) then we would never have insurance woes?
I know the thought of going back in is crazy!! I shouldn't even suggest the thought of that!! I was just thinking they could do a little arthroscopic tiny hole with a micro camera and just look around a bit. Yeah, easy for me to say when it's not my foot! In Star Trek they could just put a little nanobyte in you and it would make it's way to your foot and do repairs on it's own. Or just land on the imaginary Lost island and it will miraculously be healed! Too bad were still in a barbaric age of bone saws and such. Eww, just the thought of what we've done to our bones makes me shutter a bit ...
So the point of my last post would be that if my insurance denied me I would go through an appeal, have the surgery and then let the appeal work out. Then pay whatever comes out in the wash. They can't take your foot back and that is the primary goal to get the best treatment you can! Everybody's tanking in the economy so why not join the masses with Dr. bills?
I'm in a weird mood today ... must be the rain slogging my brain ....
To the best of my knowledge, OATS is not a gauranteed surgery.... My OS made this very clear to me prior to surgery and also expressed that I may need a total ankle replacement if OATS doesn't work. We chatted a little more, and I suggested that we proceed with OATS, but have an ankle replacement on back up in O.R. if he felt strongly that it wasn't going to be successful. I just had my surgery 2 weeks ago and am doing good so far... but I wonder if you shouldn't bring up the idea of total ankle replacement if this is not working... I'm a 26 year old female, and was fully prepared for total ankle because I was in so much pain all the time.
Thanks to all for the info. Unfortunately, I have no more time I can take off work b/c of the OATS. I am using it all for the surgery. If I take any time off work in the next week, I will have to reschedule OATS and right now, that is my top priority. I have an amazing support group going into this at home. My Husband (not to brag) is amazing! He is taking off work for the first week and will take longer if needed. My kids will be in school for the first week and a half...which I think will be good. But after that, they will be out for the summer. My boys are 15 and 12 and my daughter is almost 8...they will be a big help also.............my daughter will probably be the biggest help!! I'm just glad there are no small children during this!! Where do I get the crutch covers? Will they send crutches home with me from the hospital? Where can I get a shower chair (I like the removable shower head idea)? I may have to break down and do the wheelchair....but for now, I'm gonna try not to (it's a mental thing!).
Kris - so sorry to hear that you are having so much trouble. I'm thinking you said your doc won't make the call on recovery until a year post op. If this is true....try to keep your head up! Take it easy, use the boot and crutches, baby the ankle and TRY to stay positive!! Have a few drinks! We're all pulling for ya!
Glad to hear everything is falling into place for you. I got my crutches at the hospital and my insurance covered them. But you can take your own crutches if you'ld like. I got my shower chair at Wal-mart. It was about 30 dollars. I guess I could have gotten my insurance to pay for it, huh? I have a wheelchair I borrowed from someone, but haven't used it much. I didn't want my body to get weak overall and the crutches have kept me pretty strong, with the exception of my right leg of course. My apartment is pretty small, so I can't use a wheelchair anyway. One thing I did find useful, is my rolling desk chair. It elevates high enough to where my foot doesn't touch the ground and I can make myself sandwiches, or tea or whatever thanks to that.
When I was at the hospital, PT helped me set up the insurance coverage of the shower chair. I brought my own crutches from before, but they gave me a pair at the hospital too.
and I'm in the boot. My ankle hurts in that too. I might have to go to crutches. I'm going to give the dr. the 6 weeks of no activity at all so he can get a good idea of how I'm doing. I have to say that the OATs part of it I think is doing well. I'm glad I had that part done. Maybe the ligament/tendon stuff should have been done another time, I don't know.
Anyway, I'm glad you got this approved Dawn. And LIz, it sounds like you are doing just fine. Keep haning in there. I agree, the knee was the most painful part. Dawn, you are having an allograft, right? That should make things go a bit smoother for you. Let your kids know what you expect them to do now. Teach them to do laundry now, if they don't know how. That was the biggest pain for me on crutches,.
I had posted a couple of months ago. I had my 2nd OATS w/ peroneal tendon transfer, plantar fascia release and a calcaneal translational osteotomy. I am now, almost 8 mos. post. I continue to have a lot of stiffness in the a.m. or after sitting at the end of the day. Most recently I have been experiencing excruciating pain whenever I place any lateral stress to the ankle (side stepping, or placing the weight shift to the outside of the foot). The pain comes on like a flash and only lingers a little while, but over the last couple of days it's just getting worse. Pain is easier to elicit and lingers longer. Arghh!!
It just seems, from reading all of your posts, that problems after ankle surgery are more common than not. This is frustrating, and can be quite disheartening. I changed surgeons after my first OCD surgery failed. Both of my surgeons agreed that high impact activities will NEVER be a part of my life again. I am surprised to read that some of you were cleared for running eventually!
I really am sorry to hear about the difficulties some of you are having and pray that this is resolved for you all! Thanks for sharing your stories
Dawn, can I borrow your hubby for my next surgery? Brag all ya want its nice to know there's good one out there.
Sarah. I am 16 months out and I still get stiff. And while I can fully understand why it is upsetting to not be able to do the things we once loved and took for granted, I at 45 am more scared of losing my ability to walk at all. Therefore I have avoided any kind of impact activity. Maybe cause I still have a bad leg and I know that I have to preserve it till I can get more surgery but still this has almost reached the 3 year mark for me with ankle troubles (officially named trouble) and I can see that not walking sucks. So even though I would love to do some things I have come to the decision that I don't want to destroy my ankle for good.
Kris, Maybe we can all get together for a boot and crutch burning (yuk) someday. I hope this six weeks works out for the positive. Damn the boot!
Well, surgery has been cancelled for this Friday. They are having trouble locating a graft large enough. So, it has been pushed tentatively to next Friday. This has been a very rough emotional rollercoaster that I would like to get off of. But, I guess all I can do is wait.
So sorry you are in a holding pattern for surgery. It must be horribly frustrating. But you want the best graft they can possibly find so hopefully you can feel good that they are concerned to find 'the right one'.
I'm so sorry that surgery has been postponed. After all your fighting to get it done and now you have to wait. Margaret is right though, you want this to work and so you want a good graft. I hope they find one so surgery isn't delayed after next week.
I'm glad that your surgery went well and you are on your way to healing. I found that they weight bearing part even in the boot, was more difficult than when I was in a cast. Although you said you aren't weight bearing yet... I hope that you will improve and touchdown in 2 weeks won't be so bad.