TKR Knee replacements 7 weeks apart

[DogLoverx3]

Yikes! That is horrible! So they just dropped a big ole' bill on you with no warning? That's not right. I actually think it was your PT place's responsibility to see what is/isn't covered and inform you up front. You may want to ask and then see if they can work out a discount or payment plan for you. I'm sorry that happened.

Geesh, in hindsight, the ice machine would have been well worth it :-(

 

[kymammovanner]

On Saturday I got one of those explanation of benefits from the insurance company which shows what they pay, what I am responsible for etc. Called insurance this morning because on each date that I had PT, there were several charges; most were paid, but each date had a $21 charge that was denied. When I asked specifically what it was for, he said "cold therapy" which is not covered. (The form they mailed just said Medical Service.) When I looked at the booklet we get with covered/not covered services, I get "20 combined physical/occupational therapy visits per year (after 20 visits insurance company will review for medical necessity)" That's all it says about PT. Under durable medical equipment it says "Convenience items including, but not limited to heat/cold therapy are not covered." So I knew an ice machine to use at home wouldn't be covered, but I sure didn't expect them to deny part of what the therapist did.
I have 180 days to appeal which I certainly will do before paying. I haven't gotten a bill yet; I'm sure it will arrive soon.
I'll be talking to my PT about this tomorrow when I see her, and I sure won't let her use the cold therapy at the end of my visit. I'm not upset with her-actually she is a friend of almost 20 years, and don't expect her to read the fine print on everybody's insurance before she treats them. (The therapists are so busy that there is no way they could keep up on all of that.) My beef is with the insurance company. We'll see how this all works out.
Thanks for letting me vent!!

 

[Trixieknee]

So glad to hear you made thought your second tkr! You are a brave girl! Have a suggestion for you on icing...my physio uses Torex hot/cold compression sleeves. You can find them on amazon for $20 or so. They have a gel filling and you roll it up your leg providing gentle compression and icing. It feels great! I got a size large...I have a medium build and muscular legs ( for sizing purposes!) Would definitely recommend them. Hope you straightened out your insurance woes...just paid all of my "out of network" charges. Cannot believe how much this cost!

 

[kymammovanner]

Thanks, Trixie. I went to the local medical store and got something which sounds sort of like what you are talking about-it has 2 sleeves which you fill with gel packs (that you have put in the freezer) and also has velcro which holds it all in place. It's great for icing when you go to bed because when you wake up you can just slip it off and don't have to worry about getting it back into the freezer until morning, and it stays put if you move around a little bit. I wish I'd have done this before the first TKR, but better late than never, I suppose!
I spoke to my PT about insurance and like she said, first I would have to get a bill for it before I could even appeal, and then go from there. She is one of the supervisors in the department and she said she has never heard of any insurance denying the cold compression after PT. So I'm hopeful it can be resolved easily.

 

[I'm so ready]

Glad to hear you are doing so well. My first (right knee) was easier than second (left knee). Both are doing better. I had home PT for 15 visits on first knee and only 12 on second. I had a lot of problems with nerve pain which is much better now with how I take my medicine. My left knee seems to be recovering slower. I am still elevating it after I walk or do any exercise. I use 2 king size pillows stacked like picture and put 1 regular one under end to they look like a wedge. My left knee hurts when elevated to high. I Can't use ice on it either. I still can't sleep on my sides very long without hurting. Never worry about venting. It helps. I want to get in the water soon.

 

[Texan]

I had my first tkr in January and had planned on having the 2nd knee done in June. I've decided to wait until October to have it done. I'm not ready mentally to have the second one done and after reading other posts on different recoveries, I think mine has been pretty easy. Those weepy days from the 2nd and 3rd weeks are a little too fresh in my memory, haha! I am just now feeling better after 7 weeks. I still use the cryo-cuff machine. A friend let me borrow hers but the first night I used it, I woke up thinking someone was screaming in my house. It turned out it was the cryo-cuff cycling on. My husband bought a new one the next day. It is totally silent! I use it after exercise everyday so it has been worth the money. It is nice to read about everyone's different experiences so it gives others ideas of what to expect, AND what to ask about concerning insurance. I got an EOB from insurance and home p/t charged $150 per 15 minutes and they stayed an hour, twice a week. I didn't have to pay anywhere near that much but think that is ridiculous! So thankful I have insurance. I will be watching your posts @kymammovanner to see how you are progressing with your second knee. Good luck and speedy recovery!

 

[mimi53]

Had both knees done 4 weeks apart in January and February 2014. Second one was a little longer recovery. Feeling good now. Still in PT 3x a week. One week left to go. Still stiff in the morning. It a nice hot bath loosens them up!

 

[kymammovanner]

@I'm so ready and @mimi53, thanks for letting me know that the second one was a little more difficult, because that's how I feel. Not that the second is terrible, but because the first one is still kinda sore, sometimes I think I just don't have the strength I did first time around (which I probably don't). It's not just knee pain when I do my exercises, but also thigh pain which is probably just unused muscles. Fatigue is still an issue too; this morning I took a shower, did the hair and makeup, put on real clothes (not sweats) and went to church. My husband asked if I wanted to go out afterwards for lunch, which before surgery would have been "You betcha!", but today was "I just need to lie down!" It's not quite 3 weeks from the second TKR, and I'm impatient with how long recovery takes. Mimi, glad to hear you are feeling good now; can't wait till I can say I feel good.

 

[kneeper]

This seems ridiculous that a cold pack at the end of the PT session is charged for separately. :( Insurance companies sure have a racket, don't they?
Hopefully your PT is fairly close to home and you can ice when you get back.

 

[mimi53]

The FATIQUE after the second tkr was much more intense....makes sense. The body is recovering after TWO traumatic procedures. I also liked your comment about going out to lunch! There has been more than one occasion during this recovery time where my husband has asked me if I wanted to go out for dinner and I said no!!!!! The FATIQUE does get better but there are still times when my body just tells me to get on the couch, elevate and ice and binge watch Netflix! I'll be 10 weeks out for LTKR and 6 weeks out for RTKR on Wednesday. My new mantra is Patience + Perseverance!

 

[I'm so ready]

It takes time to heal. You have to let you knees guide you. Even though I had more problems with left knee, I would have surgery again. I do wish my left knee would be at same level as right so I could do more things. I have to gauge what I am able to do by slower knee. Sometimes we all have to enjoy ourselves. I went shopping with daughter and grand-daughter for prom dress. I enjoyed myself. The walking was hard, I paid for it with both knees screaming. I hope both knees will be ready for graduation. I am going.

 

[Pumpkin]

This seems ridiculous that a cold pack at the end of the PT session is charged for separately

I am a PT and we never charge for hot packs or cold packs. Ask them to remove the charges, they know that they will not be paid for by insurance.