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  • Ankle Allograft VS fusion

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    Old 06-07-2009, 12:27 PM   #16
    girlwithbadankl
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    Re: Blue Cross denies Ankle Allograft - may need fusion

    Hi ,

    Sorry I haven't been on here in a few weeks. I know how you feel. Now that my insurance has denied me, it's like I've been written off by the Dr.'s office. I have contacted an attorney to help me and that is going to be my last hope. At least I hope he can get them to pay for part of the surgery and we will have to pay for the rest. I've spoken to a number of Dr. Bugbee's patients and they are doing extremely well - one even playing tennis so I really want to try the allograft surgery before fusion. I know everyone is different. Are you considering fusion at some point? Maybe you should travel to find a new doctor that can help you? I know it's pricey. Dr. Bugbee is fairly good on email and may respond if you tell him your situation to see if he can help you. That's what I did first, then flew down to get a consultation.

    Melissa

    Last edited by Administrator; 04-12-2011 at 10:19 AM.

     
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    Old 06-08-2009, 12:09 PM   #17
    Calrunner
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    Re: Blue Cross denies Ankle Allograft - may need fusion

    I live in SoCal, and my dr. recently relocated to the Sacramento area. He's on the forefront of all this stuff, and perhaps he can help you out. Check out Dr. Eric Giza. If nothing else, he's closer to home for you!

     
    Old 06-16-2009, 10:05 AM   #18
    girlwithbadankl
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    Re: Blue Cross denies Ankle Allograft - may need fusion

    Quote:
    Originally Posted by heinselrunner View Post
    I live in SoCal, and my dr. recently relocated to the Sacramento area. He's on the forefront of all this stuff, and perhaps he can help you out. Check out Dr. Eric Giza. If nothing else, he's closer to home for you!
    Thank you for the referral. Have you had a transplant?

     
    Old 09-07-2009, 10:46 PM   #19
    techmom63
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    Re: Ankle Allograft VS fusion

    Melissa, not sure if you are still reading the boards or if you have made a decision regarding your surgery. I am in the same boat as you -- my OS in Denver recommends ankle fusion but I am really opposed to going that route. I am scheduled to see Dr. Bugbee in November to discuss possible allograft.

    Can you post an update to your situation?

    Thanks! Chris

     
    Old 09-09-2009, 08:27 AM   #20
    girlwithbadankl
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    Re: Ankle Allograft VS fusion

    Quote:
    Originally Posted by techmom63 View Post
    Melissa, not sure if you are still reading the boards or if you have made a decision regarding your surgery. I am in the same boat as you -- my OS in Denver recommends ankle fusion but I am really opposed to going that route. I am scheduled to see Dr. Bugbee in November to discuss possible allograft.

    Can you post an update to your situation?

    Thanks! Chris
    HI Chris,

    I am waiting to have my surgery by Dr. Bugbee. Bottom line is that I lost all of my appeals with Blue Cross. Surgery will cost me $30k out of pocket - all payable upfront so we are trying to get the money together. That was reduced from initial quote of $65k. I definetly want to have this surgery. My issue is I have chronic ankle instability so he will also have to shore up the tendon and that part is convered by BC. I am hoping to go on the donor list in the next month or two, then it is a 1-3 month wait for a donor. I think very highly of Dr. Bugbee but I have some suggestions if you are dealing with Yvonne, his asst. She was not very helpful in dealing with the ins. companies. If I had to do it all over again, I would have asked for a case manager at BC to walk it through. Yvonne doesn't want to place phone calls on your behalf. The issue is going to be your insurance company. These days they are trying not to cover this surgery because it is classified as "experimental" and they are denying anything they can. 5 years ago they were covering it more frequently. This is true of almost all the major carriers. There are only a handful of Dr.'s doing this procedure. Dr. Bugbee has done the most I believe. He is worth the trip for sure!

     
    Old 09-09-2009, 01:48 PM   #21
    akirka
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    Re: Ankle Allograft VS fusion

    Hey Mellisa,

    Isn't it frustrating these insurance companies? The most confusing thing is - I have BCBS and they covered my autograft surgery no questions asked. Others here who have BCBS have gone through denials but eventually had some appeals work out. I hope that happens for you. It's sad that there's no real consistency even within the same insurance company! I have to mention I have Federal BCBS since I'm a federal employee and it has added benefits over the regular BCBS. But I have had a GREAT outcome and it was very worth it. My surgery cost $9,000 for the procedure, $13,000 for the hospital. I'm surprised you would have to come up with $30,000 on your own. You do have the extra cost of the donor tissue and ligament tightening, but I had the addition of donor knee surgery ..hmmm.... So people have been denied the actual surgery but BCBS has picked up the hospital tab. I would think the hospital and ligament surgery would be covered and you may have to pay $10,000 for the surgery and let's say $7,000 for the graft? Anyway, I would keep appealing. My OS that had no problems with BCBS is in Boise, ID. Dr. Michael Coughlin if that helps! He's a top ankle surgeon!

    Abby

     
    Old 09-10-2009, 04:58 PM   #22
    techmom63
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    Re: Ankle Allograft VS fusion

    Thanks for the update, Melissa. I have spoken with Yvonne several times so far, and I do get the feeling that I will have to be my own advocate. Even getting her to schedule my appointment, after I had already communicated with Dr. Bugbee by e-mail, was a bit of an exercise.

    I REALLY appreciate the cost estimate you provided. I have already checked my insurance, Aetna, and while they will cover allograft for knee-related procedures, ankles are out of the question. They just reviewed that particular policy in June of this year, so they will probably not be inclined to make any changes. Of course, I will appeal, but expect to end up in the same boat as you ... paying out of pocket. The numbers you provided are all more "reasonable" (boy, that's a relative term) than the crazy stuff I was imagining in my head. I was worried it might be over six figures. It's upsetting to me that the insurance companies will jump at the chance to pay for you to lose your ankle altogether (fusion), but don't want anything to do with a chance for you to get a new one.

    I would love to keep in touch with you as you go through this process if you're open to it. We are about the same age, and seem to have a similar diagnosis. My end-stage ankle arthritis stems from a trimalleolar fracture with dislocation that I suffered 26 years ago when I was in college. I've always had some difficulty when the weather changes, no high heels or running, etc. over the years, but I'm now having a lot of difficulty walking and am in constant pain.

    Thanks again. You've been a big help!

    Chris

    Last edited by moderator2; 12-08-2009 at 06:21 PM. Reason: needless quote

     
    Old 11-08-2009, 06:23 PM   #23
    45cat
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    Re: Ankle Allograft VS fusion

    Hi
    I'm looking into a ankle fussion. Can you dance, golf, bowl & walk when you have on?

    Last edited by 45cat; 11-08-2009 at 06:24 PM.

     
    Old 11-08-2009, 06:27 PM   #24
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    Re: Ankle Allograft VS fusion

    Hi
    The doctor told me I'm to young to have a ankle replacement, so he suggested a ankle fussion. He told me I can dance, bowl, golf & walk if I get on. I'm asking anybody out there if that is true or not. I would like to know if there is anything else I can look into.
    Thank You

     
    Old 11-09-2009, 05:55 AM   #25
    stepbystep89
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    Re: Ankle Allograft VS fusion

    I have had an ankle fusion and I know for sure I can walk and bowl. As for golfing, I don't see why not although I am not a golfer. Dancing? It all depends on what kind of dancing you are talking about. If you want to dance like we do at weddings and such you will be able to, but ballet and anything where you need to raise up on your toes is out of the question.

     
    Old 11-10-2009, 03:42 PM   #26
    techmom63
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    Re: Ankle Allograft VS fusion

    Melissa, congratulations on your surgery! Your post is dated 11/10, so I assume when you say you had the surgery yesterday, that was 11/9. I only missed you by a couple of day! I was in to see Dr. Bugbee for my first consult on Thursday of last week, 11/5. Yvonne was supposed to be submitting the paperwork to my insurance company early this week. With any luck, I'll be on "the list" in about a month.

    Sending you warm wishes for a speedy recovery. Please keep us posted on how things are going.

    Chris

     
    Old 11-11-2009, 06:24 AM   #27
    girlwithbadankl
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    Re: Ankle Allograft VS fusion

    Chris yes we just missed each other. Where do you live again? It only took about 3 weeks for the donor do u shouldn't have to wait that long. Do you have any ligament issues as well or just deteriorated joint? Good luck with insurance. If I could make a suggestion, you will need a string letter from Bugbee and other docs to submit with the first appeal. Provide research papers by Bugbee as well. I feel I didn't do that until it went to the state and even then was late and they were already reviewing my case. Seems like they overturn INS companies only 30% of the timebuti know 2 others that did get it overturned. Keep me posted!!

     
    Old 11-11-2009, 08:36 AM   #28
    girlwithbadankl
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    Re: Ankle Allograft VS fusion

    I say try to do the allograft before fusion but only a hanful of docs do it. I know there is one in Chicago. I have the name at home if you can't find him.

     
    Old 11-11-2009, 04:22 PM   #29
    techmom63
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    Re: Ankle Allograft VS fusion

    Hi Melissa,

    I'm in Denver, so I flew in for the consult last week. I stayed at the Mission Bay Hilton, but do have friends in the area if I need to do an extended stay when it's time for surgery. You mentioned that you have a follow-up visit at 2 weeks -- are you flying back home between now and then, or just staying in San Diego until then? I think you mentioned that you have younger kids, so it's probably hard for you to be away from them. I have two kids, but they are 14 and 16, and the oldest drives, so they are somewhat self-sufficient.

    I don't have any ligament issues at all, just a completely deteriorated joint. Thanks for the suggestions on what to provide the insurance company. What is a "string letter" and what other docs should I be getting letters from? (I do have an OS that I saw in Denver who said my only option was a fusion.) I've started bookmarking Internet sites with research that I want to print out, etc. I figure I'm in for a pretty big battle, but I'm lucky to have time during the day to get as much information together as possible. My sister-in-law is also a doctor, so if I need to get access to medical journal articles, I can do that, too.

    I'm so grateful that you are on these boards and I'm able to follow your progress. You're an inspiration!

    Chris

    Last edited by moderator2; 12-08-2009 at 06:19 PM. Reason: needless quote

     
    Old 11-13-2009, 11:11 AM   #30
    girlwithbadankl
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    Re: Ankle Allograft VS fusion

    I meant "strong letter" not string letter!

     
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