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Beach Glass Beach Glass is offline
 
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Beach Glass
 
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Knee Issue
Old 10-23-2017, 11:25 AM
 
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First time I've been totally disappointed in my insurance. Guess I should consider it a portent of things to come overall with future insurance issues.

I did something to my knee in late August. Had an x-ray that showed little except for moderate arthritis - something that had been determined a long time ago. An MRI was requested by my orthopedist and denied by insurance - twice.

Their reasoning?? "Not medically necessary - go with PT and medication for 6 weeks." So that means my orthopedist was limited to making his best guess as to what my issue was as the PT needs some kind of starting point.

Love my PT clinic - everyone there is top notch. But because we don't have a firm diagnosis (because of a lack of an MRI), we all feel like this is some sort of huge "guess and check" problem. Right now, they feel it MAY be a hamstring issue, so they've beefed up the hamstring exercises. Last week it was working on my quad muscles. I'm sure that all the exercises I do are beneficial, but would have appreciated using my LIMITED number of visits (again, because of insurance) to the best advantage.

ARGH. Thanks for letting me vent.


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mhugs mhugs is online now
 
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Insurance Stinks!!!
Old 10-23-2017, 12:12 PM
 
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Well at least at times...

They are telling doctors to not prescribe certain medications for pain, okay...but they won't pay for alternatives like acupuncture, massage, Tens etc.

Then when they do pay for things like PT, they limit the visits.

Anyway, sorry your knee is hurting and that they waon't pay for the MRI.
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knee issue
Old 10-23-2017, 12:37 PM
 
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It can be tough diagnosing knee issues especially with arthritis as it is a chronic condition. I also have knee osteoarthritis, and have had knee pain at times. My dr. has told me that it can heal but the arthritis can cause the same problems to return.
When you are feeling better, check with your dr. to give you permission to join in water walk/ Aquasize or AquaAerobics classes at your local pool. Some pools even have specific classes for those with arthritis. Water exercise works wonders for me!
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Old 10-23-2017, 02:06 PM
 
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Sorry about your pain. I have arthritis in my neck but an MRI didn't reveal anything or change treatment, maybe that's their reasoning. I had a 376.00 copay now I wish I'd just skipped it.

I agree insurance companies should not make treatment decisions.
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Old 10-23-2017, 06:46 PM
 
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I hope the PT helps and you feel better SOON! I cannot believe they would not cover an MRI for something like that!

Nancy


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Old 10-25-2017, 09:08 AM
 
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I hope you knee heals with out a lot of problems. I think denying the MRI was crazy because what if the things PT is having you do actually exacerbates the whole thing? Keep us informed please!
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knee
Old 10-25-2017, 09:51 AM
 
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My DH suffered a torn meniscus during tai chi training. He went through the same thing as you described with the insurance company. An x-ray showed arthritis. The insurance company refused an MRI. His doctor told him to use cold packs and sent him to PT for a few sessions. He also said that knee problems are very common among people over 55 and usually go away by themselves, so he told DH to just wait it out.
DH has a very high thresh hold for pain, but he was clearly in pain for months, and used a cane for walking. After six months he went back to see his doctor, and again, the insurance company refused the MRI and his doctor told him to wait it out. It took almost a year before he had an MRI which showed the torn meniscus, and another 4 months before the insurance agreed to the minor surgery that was required to fix it.
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Guess I should consider it a portent of things to come overall with future insurance issues.
DH has fully recovered, but the whole insurance situation has left a bad taste in our mouths.
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