Pre-Cert Denial

[Loon]

Thanks for the comments. I haven't met the surgeon yet but my regular doctor sent him a referral and told me that he has done obese people's knee replacements with no problems. If he's willing and able I wouldn't think the insurance would object. I hope not anyway. If he can't replace my knees maybe he can amputate my legs. Is that an option I wonder.

 

[Mutti3]

When you meet your surgeon discuss your situation, concerns, and options available to help you. Once you see the doctor, get your questions answered you will feel better.

 

[Celle]

If he can't replace my knees maybe he can amputate my legs. Is that an option I wonder.

No. That's not an option. I hope you were joking.

My son has an above-knee amputation of one leg.
Although he walks well with an artificial leg, without even a stick, he still has problems. There are days when he has to use crutches, because the prosthesis has worn blisters on his stump. He can't walk far, either.

Hot days are agony for him, because there is no way that the sweat from his leg can evaporate. It pools inside his prosthesis, making his skin soft and more easily damaged.
He frequently gets boils on his stump because of this.

Thanks to having to use crutches frequently for 15 years, he is developing shoulder problems. When his shoulders eventually give out, he will be in a wheelchair.

 

[Loon]

Celle, I was not joking. The thought has crossed my mind more than once. I guess I'm deparate. Thank you for telling me about your son. I'm sorry for his problems. I do know a man who lives down the road who lost both his legs in a plane crash years ago. He gets around on his artificial legs quite well and even takes care of his wife who has dementia. I don't know him well though so I'm sure he probably has problems as well. I guess I'll just take it one day at a time and what will be will be. I have to relax and accept whatever my fate will be.

 

[SusieShoes]

I guess I'll just take it one day at a time and what will be will be. I have to relax and accept whatever my fate will be.

Funny thing about fate... you don't have to accept it. I think you should keep fighting all the way to get what you need. If you are denied surgery this time, that doesn't mean you will be denied it the next time you try. So keep trying. We've seen many cases here where people have to get past obstacles, including run-arounds by surgeons, hospitals, insurance companies, national health institutions, and, well, all kinds of things, until they find the surgeon that will do their surgery. It's a triumph when they do, and they earned their way to it through grit and determination.

You can get your surgery. If new knees are what you need, they're worth fighting for! You are worth fighting for.

 

[Celle]

Celle, I was not joking. The thought has crossed my mind more than once. I guess I'm deparate. Thank you for telling me about your son. I'm sorry for his problems. I do know a man who lives down the road who lost both his legs in a plane crash years ago. He gets around on his artificial legs quite well and even takes care of his wife who has dementia. I don't know him well though so I'm sure he probably has problems as well. I guess I'll just take it one day at a time and what will be will be. I have to relax and accept whatever my fate will be.

Believe me, amputation is not something to be undertaken lightly. It is only done when there is no other possible solution.

I fully believe that the person you know will also have problems with his amputations, but they aren't something that is usually shared. I wanted you to be aware of the reality.

A surgeon who will not replace your knees because of your BMI will not be prepared to do an amputation either.

I do hope that you find someone who will replace your knees.

 

[Jajakio]

Take it one step at a time. Meet with the new surgeon. Ask lots of questions. If he says no, find out what it would take to turn it into a yes. How much weight would you have to lose, etc. Different insurances and even hospitals have requirements of their own but a good surgeons office is used to working with that. In my case, first I had to lose 40 pounds (not easy when you can barely walk) the insurance turned me down once( Surgeons insurance staff did a good job of sending more paperwork and i was eventually approved), then finally we couldn't coordinate the surgeon with hospitals approved by insurance and i had to pick a different surgeon.

It sounds overwhelming but it all worked out fine in the end. I'm nearly 9 months out from my new knee and haven't been this active in years. Everything is good. It's worth the effort and even if i did have a setback or two, persistence was worth it. I am no longer in pain, i can walk for hours and i have my life back. I hope the same happens for you. Dont give up!

 

[Tired2007]

I’m posting for my mom now. She’s currently in surgery. Aetna is the “big” insurer with the hospital system insurer being under it. She got her spinal anesthesia. The manufacturer is hoping to return to “normal” levels come end of April.

 

[SusieShoes]

Sending my thoughts for your mom on her surgery! It’s a whole new journey on the other side. Hope to see her there soon.

 

[Tired2007]

Sending my thoughts for your mom on her surgery! It’s a whole new journey on the other side. Hope to see her there soon.

Thank you! She’s doing fairly well considering two knees! Surgeon was surprised she could lift both legs off bed so well today. He said he finds few are able or willing to do so. Said both of her knees were pretty crappy and bad. Everyone in hospital staff kept telling her she looks so good. They all thought she was in for something else! Haha Overall, doing well. Now when 10 am comes...