Anyone have problems with insurance paying for other treatments after surgery?

[Katcloudshepherd 630]

Hello everyone,

I have been denied by my insurance,(Humana PPO, Federal Employee), for Supartz injections in my knees. These are injections made from rooster combs which help with osteoarthritis and other knee problems. I understand the actual drug is expensive.

I just can't help but wonder since my insurance spent a good deal of money on my surgery last year, if they are going to start denying me medical treatment for other things.

Anyone else have this problem?

Kathleen

[BigGirlPanties 957]

Every insurance is different on what they approve and why... did you call them to check? Sometimes it needs an authorization from the dr.

The surgery is now considered "preventative" for my insurance companies...so that's why it gets approved more these days...also "morbid obesity" is a diagnosis code for insurances, so you don't have to have any other co-morbidities.

Sometimes the dr can give you something similiar that your insurance will approve, they just have to check... I'm sure it doesn't have anything to do with your surgery itself.

[Katcloudshepherd 630]

BigGirlPanties,

I've left a message with the Doctor's Clinical and Surgical Coordinator. I asked about contacting the insurance company. My last converstion with the doctor was that the insurance company wanted a doctor of THEIRS to talk to him to "justify" the treatment.

I had the Supartz injections treatment a few months before I had the WLS. I had no problem with my insurance company then--same insurance company now, same doctor. I was due to have the Supartz injections treatment again this month as it had been 6 months since the previous treatment.

My knees are so bad that my doctor said they need to be replaced but I'm too young. Replacement knees are only good for about 15 years--if you are NOT overweight. I'm 6 years out from the age of 55 where knee replacements are normally done. I'm trying to put the surgery off as long as possible because it is major invasive surgery replacing your knee joints. My knees are the one of the MAJOR reasons I had WLS.

I'm even willing to pay for the treatment myself, (I'm hoping I have enough money to pay it over time),--that was the other question I asked was how much if I pay out of pocket. I'm afraid if I pay out of pocket--the insurance will never pay for it again.

Kathleen

[BigGirlPanties 957]

that's called a Peer-to-Peer review...and not all that uncommon for an expensive procedure or injection...

hopefully they can get that approved at that time...

good luck to you... I know what you mean about the knees....I have RA and need knee replacement...which is why I had the surgery as well...it has helped me immensely... I no longer need a cane/walker everytime I go somewhere (like to the bathroom, as pre-surgery) ... maybe next year I can get my knees done

Edited February 21, 2014 by BigGirlPanties