Cigna just approved the allograft - Foot Problems Message Board

Pam Beeson · 05-11-2009, 06:14 AM

HI everyone;
I had surgery (subtalar joint with bone graft) (cadaver bone) on 2-2-2009 third fusion
had final cast removed on 5-8-09 have walking boot now next appt is 6-12-2009
seems to feel real good can walk pretty well in boot so far no swelling and not a whole lot of pain. first two fusions were in 2003 last one came apart about 1 year ago still not sure why. just hope this one stays together (different doctor now) also never had bone graft before. sure feels alot different than the first two seems to be alot tighter than before almost feels like other foot only thing i notice is that i still limp a little think maybe that is because it is still new and have to work on tendons and ligaments to get back strong again. i am hoping not to have the limp anymore but if i do then i guess it is better than all the pain and swelling i had before. hope this helps some to not get to discouraged it just takes time good luck to all and sorry to hear some of you still have problems your posts have all helped me get through this (again). also doctor says maybe no pt he feels they sometimes undo things he has fixed will have to see next time i have a visit. good luck to all.

dbast · 05-11-2009, 06:34 AM

I am with Kim, as I also haven't posted due to bad news. My insurance co has yet again denied this. My OS did a peer to peer and he and I both had requested it be with an Ortho, but instead the guy was a Family Practice physician! This Dr referred him to s/w the Ortho on staff, but due to the rule of only being allowed one peer to peer, we are having problems getting this done. Supposedly we will hear something tomorrow, so we'll see. I did ask him though, what my options are if this gets denied and he said I have none. He said "you will just have to walk around until this thing collapses, which won't be too far off, and then we'll be looking at fusion or replacement." I can quote that because I remember it vividly as it scared the crap out of me. Now I feel like a walking time bomb!!! He said he absolutely will not do an autograft b/c of the size of the lesion (20mm) due to the morbitity it would cause to my knee by taking that much. He and his office manager both suggested (in round about ways) that I s/w an attorney about a)the insurance company and b)the previous OS letting this go. I really don't want to get into the whole legal battles, I just want this fixed!! I am taking meds daily for pain and swelling and the pain is getting worse. I've noticed lately that it hurts real bad when I push the brake in the car...I realized this when I noticed that I switch to using my left foot for the brake sometimes. This is ridiculous!! So, maybe I will have better news tomorrow, but I am not counting on it. The insurance company says this is the final step we can take.

Dawn

Pam Beeson · 05-11-2009, 07:08 AM

Dawn;
Not sure what is going on with your insurance but it seems they just screwed you by using a family physician and not another ortho doc for the peer to peer consult that just doesn't seem right. sounds like the insurance co. doesn't want to work with you very well if it was me i would push it for another consult with the peer to peer consult and make sure they use an ortho doc this time preferably one that specializes in foot and ankle surgeries. maybe you will have to get an attorney. so sorry for all your troubles with insurance especially when you have pain it really seems to intensify things. try to hang in there keep on insurance co. until they do it right if it was me i would be making some calls all day every day you can't live in all that pain your feet are what keep things going. p.s get a copy of all medical records from doctors you have seen. I had to just to get the workers comp insurance company to do my surgery this seemed to help when it went to the court originally to have the surgery done case had been closed from insurance had to go through all that stuff just to get case reopened injury never did heal after 2 years of shots and pt it seemed like it took insurance forever to get things moving again. but i stayed on it daily persistance paid off in my case. good luck hang in there. ps also to many pain meds can mess up your stomach especially nsaids. not good for long periods of time it won't only be your foot that is causing you problems keep good records just in case you might need them if it has to go to a court for action.

dbast · 05-14-2009, 07:16 AM

OH MY GOD!!!!!!!!!!!! After all this fighting and argueing (?).....Cigna just approved the allograft AND I do not see any stipulations or exclusions to the approval. Yesterday, my OS office called and said that they were finally able to s/w the Dr we had been trying to get ahold of for a week (this was the doc they told us was their OS) and guess what.....he is an OB/GYN!!!! So, he upheld the denial also b/c he has no clue about this stuff but also said we need to s/w an Ortho and that he would pass the message along but would not give a time frame on if or when the OS would call. Well, I called Cigna (I cheated and took the provider routes throught the phone) and s/w this doc's office and gave them a piece of my mind about the runaround we have been getting and told them I was going to call an attorney today. Well, I get to work today and MY OS office calls me and says the approval letter was on their fax when they walked in this AM. Can you belive that??????

K_Lana · 05-14-2009, 09:12 AM

YEY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!

I'm so happy for you! See! It is worth it to keep pestering them. Way to go!