Meniscus repair or Total Knee Replacement

[Sheryl]

1 hour ago, notrub said:

I get this (costly) stuff from the dermatologist at the hospital.  Excuse me for being dumb (as in stupid) but I thought urea means urine.  Immersing myself in pee does not appeal but if there is a derivative that helps this aching body of mine I would like to learn of it.  Thanks. 🙏🏼🙂

This is not going to do anything for aches. It is helpful for certain types of skin problems.

 

Urea is a byproduct of protein metabolism. Urine contains it  (hence its name) and so do other things (including fertilizers).

[touch]

So what has happened so far ?

The insurance company (ACS) sent me an email that my torn meniscus root shouldn't be treated by surgery until 4-8 weeks of "conservative treatment" had been done.

I've had three weeks of PT with all you can throw at it, Ultrasound, TENS, Laser and heat treatment and it has now gone five weeks since the accident. DR, Bancha says that surgery should be performed as soon as possible and another orthopedic surgeon that I consulted for a second opinion agrees, not the insurance company though.

I don't want to have surgery if it's not needed, nor do I want to wait longer if , in the end, I have to have surgery anyway.

Not being a medical professional one is put in a very difficult position when doctors and insurance companies don't agree.

'

[Sheryl]

7 hours ago, touch said:

So what has happened so far ?

The insurance company (ACS) sent me an email that my torn meniscus root shouldn't be treated by surgery until 4-8 weeks of "conservative treatment" had been done.

I've had three weeks of PT with all you can throw at it, Ultrasound, TENS, Laser and heat treatment and it has now gone five weeks since the accident. DR, Bancha says that surgery should be performed as soon as possible and another orthopedic surgeon that I consulted for a second opinion agrees, not the insurance company though.

I don't want to have surgery if it's not needed, nor do I want to wait longer if , in the end, I have to have surgery anyway.

Not being a medical professional one is put in a very difficult position when doctors and insurance companies don't agree.

'

I don't follow.

 

Insurance company says "4- 8 weeks" and by your account you have had 5 weeks of conservative treatment already.

 

So should meet their critieria.

 

I think a matter of getting the doctor to adequately document this.

 

Communication at this point should be between the hospital and the insurer, not you and the insurer. Almost always a mistake to informally contact the insurer yourself in these situations. 

 

The hospital third party payer office should  submit a request for guarantee of payment (GOP) to the insurer. Tell them, and the doctor that in it,  he needs to document that 5 weeks of conservative treatment have already passed, PT already tried etc etc and no improvement.

[touch]

@Sheryl of course you are correct. The insurance company has been provided with a Second Opinion and now reversed their decision.

GOP will be provided as soon as I have definitive date for surgery.

Thank you for your help