Surgery and Insurance Company

[ChattiPatti]

What is the name of your state? Florida
I have been diagnosed with a torn Medial Meniscus in left knee. Have been to therapy, and therapist stopped therapy as it was doing nothing.
I have been fit with a leg brace and have worn it for 2 months now. No help.
The insurance company called me and told me to tell the doctor that if surgery is needed do it as they want my leg fixed.
Well, I went to the doctor the other day and told him. He said that the meniscus cannot be repaired. I will need total knee replacement. He set an appointment with his partner who would do the surgery.
Well, lo and behold I get a call yesterday from the insurance company that they cancelled my appt. and said everything is on hold. They do not want me to have the knee replacement.
Now mind you, there has never been prior injuries to the knee, I had no problems until this accident.
My attorney said they will have to petition them to do the surgery.
Has anyone had this happen? And does the insurance company give in?
I have not been released to work, as I can hardly stand on leg. But the insurance company has tried to get doctor to release me. He has not.
Thanks in advance for any advise.

 

[weenor]

Thank your lucky stars the insurance company canceled that surgery. A knee replacement is a much more serious surgery than the arthroscopic surgery performed on menicus tears. If you are under 40 you will likely have to have the knee replaced again in your life time. What is needed is second opinion which is probably what the insurance company is trying to arrange with your lawyer. You should get a second opinion anytime a surgeon wants to cut on you.

 

[ChattiPatti]

Thank You for your reply.
I am 53, and I know it is a serious surgery. I also was told that the knee may only last about 12 years.
I wanted to get second opinion, but Insurance company did not give me a chance to ask for it.
The doctor said that my knee is bone on bone and that the meniscus is unrepairable.
So hopefully they will set up an appointment with another doctor and we shall see what happens.

 

[wooglin]

you really need a second opinion. there are other alternatives. an arthroscopic procedure with a partial menisectomy and debridement of the articular cartilage is always an option. just because the meniscus is torn doesn't mean it has to be repaired. if they do the arthroscopy and determine thet you truly have degenerative disease of joint, then you may still need a knee replacement. but hold off at 53. other alternatives include synvisc or hyalgan injections afterwards for the arthritis.