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Medical Forum / Diseases and Disorders / Arthritis / October 2005Buechel-Pappas Total Ankle Prosthesis - Questions about cost
My Ortho doctor wants to do an ankle fusion on my left ankle but I am dead set against having it done. In studying options for ankle replacement, I discovered that a Dr. Feldman in Florida performs the Buechel-Pappas ankle replacement procedure. I have really good Blue Cross insurance (Blue Cross of Illinois)through my company that has covered nearly everything related to the why and how I ended up with 2 severely arthritic ankles. HOWEVER, I just called them about the BP procedure and they said that it was NOT a covered item. Since I am so detemined to not have my ankle fused, I am considering paying for this myself. Since BCBS will cover everything involved with the ankle fusion surgery, I guess BCBS would cover all the hospital expenses involved with the BP surgery(room,anethesia,etc.) with the exception of the actual cost of the BP prothesis and surgery. I am sure that others in this group have run up against this issue so I ask this question: Does anyone know what this might cost me, out of pocket? Thanks a lot for any replies. > My Ortho doctor wants to do an ankle fusion on my left ankle but I am > dead set against having it done. [quoted text clipped - 10 lines] > it was NOT a covered item. Since I am so detemined to not have my ankle > fused, I am considering paying for this myself. If you're serious about this, start getting all your documentation. You'll need to see if you're a candidate for the procedure, and if so get that in writing. Then submit this to BCBS and make sure they give you a written response. When they do, and it sounds like it'll be a negative response, appeal it. Exhaust your options before paying for it yourself unless you really cannot wait. > Since BCBS will cover everything involved with the ankle fusion > surgery, I guess BCBS would cover all the hospital expenses involved > with the BP surgery(room,anethesia,etc.) with the exception of the > actual cost of the BP prothesis and surgery. Confirm that in writing with them. You don't want any suprises during recovery. Eventually I may have to have an ankle fusion, but my osteonecrotic and collapsed talus is actually one of the least painful problems for me right now :-( > I am sure that others in this group have run up against this issue so I > ask this question: > Does anyone know what this might cost me, out of pocket? > > Thanks a lot for any replies.  Signaturespammage trappage: remove the underscores to reply I'm going to die rather sooner than I'd like. I tried to protect my neighbours from crime, and became the victim of it. Complications in hospital following this resulted in a serious illness. I now need a bone marrow transplant. Many people around the world are waiting for a marrow transplant, too. Please volunteer to be a marrow donor: http://www.abmdr.org.au/ http://www.marrow.org/ What Ari said about clarifying EVERYTHING with BCBS before moving forward makes infinite sense. I strongly suspect that BCBS will NOT cover the costs associated with an uncovered procedure, so you'd probably be on the hook for ALL costs associated with the operation. Check with how they'd cover any follow-up care also. Then, inquire of the doctor you are considering about potential costs. Also check things out with the hospital where you'd be staying about charges if indeed BCBS will not cover the other costs. If you are still determined to go that route, you can try negotiating prices provided you are able to pay the costs up front. Insurance companies are able to negotiateon costs because the providers know they will be paid and they want the business. If you can truly guarantee payment, they might be willing to come down some on price. Now, why are you so totally opposed to the ankle fusion? Many people have had it done and found it to be a blessing. I know several of them personally, including my dad and a close family friend. What is it that makes you dislike the idea so much? SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare I do appreciate the responses so please don't take offense at anything I may say. As far as being in a hurry or not, I can wait. There are only a few doctors who do the BP technique and one is Dr. Feldman in Florida. My cost question is my trying to get an idea of what this might cost before I go the route of getting my Xrays, having the doctor look at them,flying down to Florida for the in person consultation,etc. I made the asumption that BCBS will cover the other stuff because they have covered everything associated with the 5 operations to my legs which I have had these past 2 years. You asked why I am opposed? Lotss of reasons: 1) While I do wear orthotic braces that help make it so I can walk more than a few feet without being in a lot of pain, I still get a bit of range of motion from the ankles which I will lose completely if I fuse the ankles. 2) I don't want to end up with arthritis of the toes that utlimately shows up after a fusion 3) I don't want to end up having to have a knee and/or hip replacement down the road because ankle fusion messes up your gait and those 2 are a very common side effect. 4) I was a very active person (scuba diving,bicycling,water/snow skiing,walked several miles a day for exercise,etc. ) and while I realize I can never do most of them ever again, I sure would like to be able to get the simple things in life back. Like being able to drive a clutch on a car or be able to walk up stairs more than one at a time and without a cane. Fusing the ankle eliminates ALL these things and I am holding out hope that I can get something of my 'former' life back. 5) The list goes on but you get the idea: There are bad side effects from an ankle fusion and I would really like to get as many years of quasi normal movement before the ankle replacement fails. I ask again. Has anyone in this group had this operation and know what a ballpark cost is? I can tell by one of the questions in the second post that maybe I am not very serious about this. I am and if I have to spend $20,000 on this operation then so be it. Thanks >I do appreciate the responses so please don't take offense at anything > I may say. [quoted text clipped - 47 lines] > > Thanks If this is what you want and if it will have to be self pay, have you looked at the option of having it done outside the United States? Not saying that would be good, bad, or possible. But it might be a less expensive option. Jo > If this is what you want and if it will have to be self pay, have you looked > at the option of having it done outside the United States? good point. I know both Thailand and India have hospitals now that specialize in treating foreign patients and that provide fine care. Just saw the repeat of the show about it on 60 Minutes. But from what you say, you apparently know where the few docs who do this are. Do clarify things with BCBS though. I worked in hospitals for years and can tell you that insurance can be very annoying about not covering ANYTHING to do with an unapproved procedure. Some of them won't even cover care for a post-op infection that follows, though the better companies/better plans aren't that arrogant. Still, you might as well know what you'll be dealing with going in. Can't help you at all on the actual cost, but I somehow suspect the base private pay cost would be more than the $20,00 you mention. I say that based ont he fact that my hysterectomy, 6 years ago, would have run us a total of $23,000 without the insurance and insurance related discounts. And that was a simpler operation, no post-op PT needed and I was out of the hospital on my 3rd post-op day. > Not saying that would be good, bad, or possible. But it might be a less > expensive option. > > Jo SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare Jo- I don't follow every thread but I did wear AirCast braces for 4 years and my ankles more or less self-fused and since Remicade I am doing really well. My RD in Lincoln talked about an ortho guy in SD who has done very many ankle replacements (don't know your location). Jan O' >>I do appreciate the responses so please don't take offense at anything >> I may say. [quoted text clipped - 55 lines] > > Jo > I ask again. Has anyone in this group had this operation and know what > a ballpark cost is? the FAQ for a doctor who does this procedure in NJ places the surgeon's fee for an uncomplicated replacement at $8,500 (http://njortho.com/ankle.html). SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare > I do appreciate the responses so please don't take offense at anything > I may say. [quoted text clipped - 17 lines] > range of motion from the ankles which I will lose completely if I fuse > the ankles. Yep. Your walk will certainly change afterwards. That said, I know a small guy at uni who had one of his ankles fused while still a toddler. He was born without a fibula on one leg, so the ankle had to be fused. He gets around pretty well, but he only weighs about 120 pounds. > 2) I don't want to end up with arthritis of the toes that utlimately > shows up after a fusion And the sub-talar joints, assuming they don't fuse these as well. I have no dorsiflexion left in my left ankle and the subtalar joints are showing signs of degeneration in MRIs. The left foot was also the first one to break in me (see my post a couple of days after the start of this thread about getting an electric wheelchair). > 3) I don't want to end up having to have a knee and/or hip replacement > down the road because ankle fusion messes up your gait and those 2 are > a very common side effect. I can see that. I haven't heard about it, but I can imagine it throwing stress through all the joints in the chain, including the spine. > 4) I was a very active person (scuba diving,bicycling,water/snow > skiing,walked several miles a day for exercise,etc. ) and while I > realize I can never do most of them ever again, I sure would like to be > able to get the simple things in life back. Yeah, flippers for snorkelling hurt the heck out of my left ankle. Bicycling isn't too much of an issue (it's only safe for me to stationary cycle now, as a fall even at a stand still will almost certainly break me or kill me from a regular bike) because you can position the axle of the pedal underneath the middle of the foot and still function fairly well, as I've discovered. You can even play around with different angles of the foot and keep the pedal under the ball of the foot, but the stress on the knees feels different when I do this. Weight training can be tailored to accomodate a wide range of orthopaedic problems. > Like being able to drive a clutch on a car or be able to walk up stairs > more than one at a time and without a cane. Clutches can be modified with a block to allow you to use them with a fused ankle, but it requires hip movement. > Fusing the ankle eliminates ALL these things and I am holding out hope > that I can get something of my 'former' life back. Go for it, if it's possible. Remember to be realistic about the longevity of ankle replacements and the abuse that ankle replacements can take. > 5) The list goes on but you get the idea: There are bad side effects > from an ankle fusion and I would really like to get as many years of [quoted text clipped - 8 lines] > > Thanks Signaturespammage trappage: remove the underscores to reply I'm going to die rather sooner than I'd like. I tried to protect my neighbours from crime, and became the victim of it. Complications in hospital following this resulted in a serious illness. I now need a bone marrow transplant. Many people around the world are waiting for a marrow transplant, too. Please volunteer to be a marrow donor: http://www.abmdr.org.au/ http://www.marrow.org/ Joe, As for cost..I haven't had an ankle replaced but I had my elbow replaced in Dec. The prothesis itself was $13,000. Total billing for 4 hours operating time and 1 nites hospital stay as well as the surgeon and related costs ran right at $50,000. There was another 5,000 for rehab. I would suspect rehab costs would be higher since you are dealing with a weight bearing joint. My 2003 shoulder replacement was about $ 65,000 total including rehab. Of course this is insurance billing, actual payments were much lower. Karen >I do appreciate the responses so please don't take offense at anything > I may say. [quoted text clipped - 47 lines] > > Thanks Hi Joe, I have one ankle fused and one replaced so I wanted to give you my experience and two-cents to your questions. My replaced ankle is not the BP type, but is a Star device by LinkAmerica. My doc was Roger Mann in Oakland California. He's done lots of these and is working on getting FDA approval for these Star ankles, but I'm not sure if he's currently doing new patients. You could give him a call if you wanted to find out, though. Even though I have one fused ankle, I'm in total agreement with you that it's a last-resort option. Mine was done when I was 16, back when everyone still thought that replacements were not possible. I've regretted and hated it ever since. It has handicapped me a bit and I do have problems with the toes of that foot. I do drive stick shift, though. Just so you know it IS possible. I do have to use my whole leg to push the clutch in, which means having my seat a little closer to the wheel than you otherwise would. But I'm used to that now and love manual trannies so much that I won't buy automatics. I LOVE my Star ankle and highly recommend replacement. After you get one, you shouldn't do high-impact activities of course, but you can still do many things. I do scuba dive on occasion, walk as much as I can (which is not enough) and can bicycle with no problem. You can do anything you want, you'll just have to monitor your ankle for excess wear and tear. On to your main question, my replacement was done in 2000 and I had BCBS cover it. I'm a little fuzzy on both my out-of-pocket costs and the whole because they had me pay for it at first and then the doc reimbursed me after they saw how much the BCBS paid. I got a refund check for over $2000 which paid for my then-hubby's lasik! So I would guess at that time the cost was around 2 - 4K. I don't know if the cost has gone up or down since then, though. Hope this helps! - Sharon "Gravity... is a harsh mistress!" Sharon, Thanks for those 'real world' experiences. I can not get my family to understand why I am so against fusing the ankle. Folks that have not been through this never understand. Right now with my ankle orthotic devices which really limit range of motion, I could not even test drive my brother's new Mazda RX-8 because of the manual transmission. I can function pretty well (pain wise) without the right one but I would not dare leave the house without wearing the left ankle orthotic and my cane. For the first time since I have been driving, I bought a car with an automatic and that was a Nissan 350Z which begs for the 6 speed manual instead of the 5 speed automatic that I had to get. Impractical car but it is in place of the 5 week Australia trip for scuba diving and the the outback on horses that I had been saving for years when I hit my BIG birthday a few months ago. My plan is to see if the BP will work for me (My current doctor said that the damage is too great for the 'agility ankle' and hes does not do the BP) and then go to battle with BCBS. Thanks for your welcome encouragement. Joe > ......................... > [quoted text clipped - 5 lines] > > Joe Joe, what kind of ankle orthotic do you use? I'm an inquiring mind, suffering two lousy ankles, and looking at surgery as one option. Blechhhhhh, I don't want to go there. TIA SignatureDi zinkadoodle at gmail dot com www.pbase.com/di I wish I could remember the name but it is fitted to ME. It is a leather device with hard plastic embedded in it that encases my ankle&foot from above the socks to where my toes start. It is has laces on it so you slip your foot in it and tie it up tight. The plastic buried in the leather makes it such that this whole thing is almost 100% imovable. I wear one on the left ankle all the time and the right one when I know I am going to overstress that ankle with such activities as waxing my car. The insurance company paid ~$1500 for EACH one. Before you look at surgery, PLEASE try one of the orthotics like I just described which basically immobilizes the ankle. Before I was fitted with these,I could not even make it through a full shopping trip at the grocery store because the left ankle hurt SO bad. My ortho COULD have fused my broken wrist BUT--I would LOSE range of motion I NIXED the idea--and asked for a splint. I have arthritis in both wrists now--no wrist fusion. So I understand the reluctance......and knew a person with a fused foot and boy did she regret it, Bonnie Bonnie. One only has to 'google' on ankle fusion and one will find LOTS of stories like yours as well as all the long term complications. I am too young (not all that young, though :) ) to resign myself to a life 25-30 years from now where I am stuck in a wheel chair because all the joints have failed due to the stresses of a fusion operation done today. In my case, I am ultimatelty going to have to consider what to do about the right ankle as well because that is starting to go. Thanks for responding. Did Blue Cross say WHY it wasn't a covered procedure? Before I would look into paying for it myself I would file an appeal with BC/BS. 80% of all appeals are generally approved on the first try. Karen. > My Ortho doctor wants to do an ankle fusion on my left ankle but I am > dead set against having it done. [quoted text clipped - 21 lines] > > Thanks a lot for any replies. Karen, I simply called them with the operation code and got the answer that I said. Because we are self insured (my company is near the top of the Fortune 500 who self insures and uses BCBS to administer the plan), I can work my way through my company and potentially get them to 'order' BCBS to pay. I am merely fact finding since 1) I have to send my Xrays to Dr, Feldman in Florida to see if the BP will even work and 2) my doctor here in Baltimore, is going to start pushing me to have the fusion done now that summer is over and I can 'afford' to be more sedentary. Final thing about why BCBS said it was not covered: The BP procedure is NOT yet FDA approved. I have the Depuy agility ankle prosthesis which is covered by BC/BS email me if ya have questions.kropos@rap.midco.net kro_@rap.midco.net, My current doctor is Dr, Meyerson (got famous for treating Terrel Owens from the Eagles before the superbowl last year) and his speciality IS the agility ankle. I picked him because he is famous for his innovative treatments. He told me a few months ago when I first saw him (I am on my third ortho doctor - nothing to do with this fusion issue. It's a much longer story that is not germaine) that I am NOT a candidate for the agility ankle. Dr. Feldman ,who is one of the few doctors in the USA who does the BP replacement, and is in Florida has emailed me and of course knew Dr. Meyerson . He is the one who explained to me that Dr. Myerson is the best at the agility ankle but does not do the BP ankle. I have a folloup with Dr. Myerson the first week in October and whould like to have my ducks lined up before I see him. He is a very fine person and I do NOT want to alienate him - unlike the Hopkins doctors who think they are GOD. Joe I was told by my local ortho I was not a candidate for the agility. I went to Dr. Alvine the inventor of the agility who did find I was a candidate and did the surgery. I would be cautious about the BP which has been known to have problems. Kate > I have the Depuy agility ankle prosthesis which is covered by BC/BS > email me if ya have questions.kropos@rap.midco.net Kate, I have emailed you but it bounced. Perhaps you have it TOO spam collector protected:) The shot version in my email was that my local ortho doctor (DR. Meyerson) changed his tune when I aw him this week and said he COULD do the Agility Ankle. I called BCBS and they said "It is is covered if medically mecessary" but after all the surgeries I have been through and the endless battles with BCBS, I want to be sure if this is covered. Did BCBS give you any problems? How well is the Agility working for you? Thanks, Joe Someone posted about this ankle replacement several years ago. Have you done a search on it in Google Groups? Duckie > My Ortho doctor wants to do an ankle fusion on my left ankle but I am > dead set against having it done. [quoted text clipped - 21 lines] > > Thanks a lot for any replies. Signature_('> (_<_) _ _('< -quack (_<_) _ __('< *QUACK!* <_{__) _('< "|,,|_" (_<_) _('< "AFLAC!" (_<_) Ruthie (followed by some number) had the BP put in about a month after my Agility was done. She had pain afterwords and had to have a revision almost immediately. She emailed me privately but never posted her abut her comlications. Shrtly therefter they toook the BP off the market. It is now considered expwerimental surgery i think though it may have been improved. there is or was also a STAR replacement. I don't know much about it. |
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