does insurance pay for computer navigation

[skigirl]

I just came back from my pre-op where i had to sign a form agreeing to pay for the computer navigation if my insurance did not pay it. I think they will pay---I will pay for it myself if necessary since I think it is so important. But, what do most insurances pay for?

I have medicare and then blue cross.

 

[Jamie]

Skigirl, I did a little Googling to see what I could find and it does appear that Medicare either will not pay for the computer assisted navigation or the payment they give ($146) is so minimal that it isn't worth much. You could find out more by calling and asking.

As for your Blue Cross, coverage varies from state to state and also from one plan to another within a specific area, so you definitely need to check your plan book or call them and ask. I have Blue Cross also (Kansas City Blue Cross Blue Shield), but I had the traditional surgery with no computer assist.

The reason Medicare gave for not supporting it was that they felt it added another layer of complexity to the operation that did not necessarily improve the outcome of a knee replacement surgery where the joint was open and could be viewed. But that doesn't mean that your secondary insurance can't pick up the tab, so it would be worth checking.

 

[Simon]

I have Blue Cross of Alabama and they did not pay for the computer part of the surgery. That part of the bill was $1100. I have had for years an excess major medical policy wit a 35,000 deductible and they covered it. The problem was I told the OS I would pay for it as I knew I would probably be covered by insurance #2 but even if I wasn't I did not mind paying for it and not to write it off while they resubmitted the claim. The second insurance did pay for it but then reversed them self because in the mean time the OS office had some how notified Blue Cross that they would write it off. I had a hard time with the OS business office understanding that the item was not covered under the policy so they were free to accept payment from me for it.

Seems like your OS office as more experience and knows Blue Cross will probably not pay. For now the Blue Cross line (at least BC in Alabama) is that the research is not there showing a better outcome with it. I know because of previous surgeries and a malalignment problem it would have been very difficult to get the implant in correctly without it.

You will probably have to pay for it yourself but if your OS uses it, he has a reason and like you said, it is worth paying for it. Most of the academic medical centers and large volume hospitals are using it. I am sure in time it will be covered.

Simon

 

[hollie9]

My Blue Cross of California would not pay for the computer navigation so the doctor ate the cost.

Hollie

 

[Josephine]

Bon appetite!

 

[skigirl]

After a long day of talking to insurance companies and the doc's office, I can see that my doctor is not interested in eating the charges for this---$700 is the charge and I had to put down a deposit before the surgery or he would not use it.

I have Blue Cross of Michigan as a secondary and it seems that they will pay for it, if there is a medical reason for its use. Since my legs are quite bowed (actually, that is the main reason that I am doing this surgery) and I have a pronounced varus thrust, they might pay. The doc has to write a letter which he has agreed to do and the office has agreed to help me with a second billing if it is denied.

According to BC it is paid if the correct billing codes are used---and no, they can't tell me the correct billing codes to use. The coder at the doc's office seemed to think that she could find the correct codes for this surgery. I am glad that I followed up on this before the surgery since I am sure I won't feel like calling five times after the surgery.

I do think the navigatioin is worth it--and we will pay the $700 if we have to do it.

 

[Jamie]

Good job, Skigirl!!! The right time to deal with any concerns like this is BEFORE the surgery is done. It can be a lot more difficult afterwards for more reasons than the fact that you might not be up to all the hassles.

 

[webbie73]

I think it is a shame that insurance companies have such a say in medical matters. In my opinion, I think a computer assisted/navigated joint replacement is the only way to go. I was fortunate that my hip replacement was completely covered by Blue Cross Healthmate. If I ever needed another replacement of any sort and the computer part was not covered I would gladly pay the cost.

Kathy

 

[skigirl]

I am in the process of collecting information on the computer navigations. There are two papers written by Korean docs who claim the computer navigation made no difference--this is what the insurance companies are using as a guide!!

I went on Medline and came up the Minimally INvasive computer assisted total knee replacement that was done in Tampa, Fla. It is on the web to view.

One of the docs, Kenneth Gustke who does 4000 knees per year said."With the computer namigations . . . we are able to accomplish that hip, knee and ankle in perfect alignmnet 100%a of the time rather than typically 80 to 85% of the time which we can do with standard insturmentation."

I am collecting all the references that I can find like that, will present them to my doc and my insurance company--it is complete bs that they won't pay for this.

 

[Josephine]

My only caveat to the "100% perfect" would be that it therefore takes at least twice the time to do the operation! All that extra anaesthetic, epidural opiates and consequences of lying still in one position which is a lot more significant that people give credit for. I'm not so sure ....

 

[hollie9]

My Doctor Coon uses computer navigation and the total surgery time is 45 minutes, that is so little time I don't worry about extra time for the computer alignment.

Hollie

 

[loggon]

My OS was one of the first to use the computer alignment in the US.

When is your surgery. I see him the end of June and will try to ask.

He never does a surgery without the computer. I don't believe it took him any longer to do the surgery and I believe him saying it was faster, because the alignment
was done by the computer. No guess work.

If the OS office will include it in the surgery code, not
separate then the insurance company should pay according to their contract with the OS.

If my insurance does not pay how I think it should be paid then I have them change the code. Usually it is their fault in the first place for using the wrong code. This happens on ekgs, xrays etc. Also on test run for annual check ups with the GYN.

I have and ins. agy. so I am use to arguing with the ins. co. for my clients. Any time you get a bill for something that is not paid by the insurance company, besure to call and see why. They should tell you if it is coding and most will let you know what it needs to be coded under.


I do hope you can get it paid because it sounds like your
surgery needs the aligment done by the computer.

Good luck.

 

[skigirl]

Jo,

I am in the process of appealing the turn down of the computer navigation and reread this post. My surgery was 90 minutes--so, the computer navigation does not add time if the surgeon is used to using it. I am pretty happy with the alignment and will pay if I have to do it[--but will argue first. Kelly

 

[sykeRN]

Hi-I am having computer assisted surgery on Monday for my LTKR. My insurance does not pay for this additional charge-it is a $863 charge--but is absolutely important to me since I have a fabulous surgeon that uses this method for knee replacements. He is well known for his expertise and good patient outcome. I researched this doctor well (in Roanoke Virginia) and expect to do very well. Even his extensive staff and operating team think of him like a "rock star" and really sing his praises--also he does about 500 knee replacements per year. Nancy

 

[skigirl]

Nancy,

My doc was a rock star too!! I am pretty happy with the outcome and certainly think the computer navigation is a big part of the success. I had a bowed leg (10 degrees) and did not want to take any chances. Ihave a Strykerf Triathelon knee. So far (12 weeks today) it has been behaving well. Good luck--my doc does 250 knees a year, but we live in Montana--there are not 500 people a year who need knees!!

But I do agree that you need to do your homework and search around for the best doc. I left an OS that I liked who did great shoulder surgeries on me for the rock star because I felt he was the best one for my knees.

I think that not enough people shop around--there have been some really sad stories on this board and some of them sound like surgeons who are either inexperienced or incompetent. It is hard to listen to a surgeon and try to evaluate his/her competence. I went with the 3,000 total knees done and 250 a year---my os decribes himself as a "One trick pony" that is what I was looking for! Kelly