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Old 11-28-2009, 10:18 AM   #61
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girlwithbadankl HB User
Re: Anyone have health insurance issues for OATS procedure?

I had to pay out of pocket for my surgery. After fighting for 1 year all the way to the state, they denied my appeal. My only coverage option was fusion, and I refuse to fuse. We paid about $22k for allograft surgery done by Dr. Bugbee in San Diego. Worth every penny. Many spend that on plastic surgery. This is a quality of life issue! Insurance companies are denying more than ever according to my doctor. It's a shame because it discourages more doctors from learning the procedure if it's not covered.

Last edited by girlwithbadankl; 11-28-2009 at 10:19 AM.

 
Old 12-03-2009, 05:36 PM   #62
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Re: Anyone have health insurance issues for OATS procedure?

My daughter had her OATS procedure done February 2009...after a year of "correspondence" with BC/BS of Arizona. I have a very full binder of all research and documents that I had sent them over that time. It almost became my part-time job fighting them to finally approve the surgery. She had 2 previous microfracture and debridements that had not worked. The pain was becoming completely unbearable...pain killers were not working.

The surgeon gave up after one denial from the insurance company. I was not giving up that easy. My argument for the "investigational" decision, was that "ALL SURGERIES WERE INVESTIGATIONAL AT ONE POINT." We were denied twice, the third time was the charm. Once we got the approval, it all fell into place. The hardest thing was waiting for the graft...we had to wait for a donor that was her approx age (18) and body size...we waited 5 months.

The 2 weeks after surgery was brutal..on her and me!! But she has done remarkable since. She had only one day of pain since then, and that was because of the rain (arthritis).

I hope this helps...sorry to go on and on.
Debbie

Last edited by Administrator; 04-12-2011 at 10:18 AM.

 
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Old 12-06-2009, 06:11 PM   #63
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LSS979 HB User
Re: Anyone have health insurance issues for OATS procedure?

Hello everyone,
I am almost a month post Oats and I am still having a degree of discomfort. Nothing serious by any means. The site of the incision and the knuckle bone are irritated. I am in a fiberglass cast now, out of the splint for two weeks. I am going back to doctor on 23rd. I am just wondering how long to expect the discomfort to continue. I am not taking pain pills regularly any longer just once during the day and a half a dose at night before bed. I am not really elevating my feet during the night when I sleep because my body doesn't want to. I say that because I kick the pillows of the bed in my sleep. Has anyone else still had discomfort almost a month post surgery? I think I am just getting paranoid because I so desperately want this to work. Okay enough of about me, hope all is well with everyone!

 
Old 07-13-2010, 09:23 AM   #64
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citizenp77 HB User
Re: Anyone have health insurance issues for OATS procedure?

I have had my OATS claim denied. I already had the surgery and it was "pre-approved" or whatever, but i think that since they ended up having to use multiple plugs, instead of a single plug it was considered experimental.

there are multiple line items and codes on my bill. right now, I am getting my claim re-looked at. Next step is an appeal.

< edited >

Last edited by hb-mod; 07-13-2010 at 11:49 AM. Reason: Please do not post personal information, such as real name and/or email.

 
Old 07-14-2010, 01:29 PM   #65
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girlwithbadankl HB User
Re: Anyone have health insurance issues for OATS procedure?

Update on my insurance issue. Though we paid out of pocket for the allograft surgery, I was also having a ligament reconstruction on my ankle at the same time that was approved. After the surgery the hospital went ahead and rebilled BC for everything at a cost of 95k and unbelievably they paid it so I got a refund for my out of pocket except for deductible! I don't know If it was a mistake or what. My doctor did send in my case in as part of an investigation going on. He was discussing his frustration directly with BC medical director. But in my case I has lost all appeals, even the state independent appeal.

Last edited by girlwithbadankl; 07-14-2010 at 01:31 PM.

 
Old 07-15-2010, 05:19 AM   #66
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K_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB UserK_Lana HB User
Re: Anyone have health insurance issues for OATS procedure?

Wow! That is great news! Gives one hope even after the fact that it can still be covered.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
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