Doctor and insurace approved knee braces

[Trail Boss]

My question is for those of you who have had their doctors and insurance company agree to pay for your braces. What did you say to the doc to get him to feel that you needed them and did you have to go several rounds of painful phone calls to the insurance company to get them to agree?

I have a doctor’s appointment coming up and I will be asking him to approve knee braces.
I’ve tweaked my knees quite often on various crashes.
I’ve had one minor surgery and always wear knee guards, but want to step up to full braces
I’m very interested in the Asterisk braces.

Thanks

 

[yzeater]

I'm interested in this too, so keep me updated

 

[Okiewan]

Asterisk Braces are not a "medical device", insurance won't cover them; that's where CTi's come in, insurance WILL cover them.

Don't have the Doc say they are for preventitive purposes, the INs. companies will turn it down. They need to be for recovery. Also, check the deductable on such things, you very well may pay more than for a set of Asterisk Cells (many prefer the cell to CTi)

 

[NVR FNSH]

What did I have to say to my doctor to get my CTI? "Do the reconstructive surgery"

Seriously, save yourself the headache of dealing with insurance and buy a set of Asteriks out of your own pocket. If you have a health care spending acct the Asteriks can be paid for out of that - mine were. I have a CTI2 for my left leg and bought a set of Asteriks because they are more comfortable than the CTI2.

Brian

 

[Trail Boss]

Thanks

Your replys make sense - I had not thought about a deductable, and don't know what mine is.
Since it's the Astericks I want I'll just pick them up on my own

It couldn't hurt to ask though - Every penny saved goes towards the new bike. :yeehaw:

 

[KiwiBird]

My two CTi2s wound up costing me over $1200 for the pair after I paid copay and deductible for Dr visits and MRIs. That said I've been extremely happy with them and the excellent customer service I've received.

 

[Okiewan]

Buwhahahaha! Kiwi is stuck with CTi's !!! :p
(just kidding big guy)

 

[endosports]

Check you ins. coverage. If you are covered for durable medical equipment then it is possible to get the *'s from ins. I have a 1000.00 limit for durable medical equip. Your doc. should work with you and just ask him it won't hurt to just ask.

You will still have to pay from your pocket and then get reimbused. This is what I did. I have a cheap hmo that costs me a whooping 154.00 a month and I am goin to use it the best I can.

 

[XRpredator]

endosports, you may have just put a pair of *s on ol' XRpredator's knees!

Time for me to go talk to the doc!

 

[endosports]

;)

 

[Trail Boss]

Well here is a direct quote from my medical coverage - They will pay 100%
for Durable medical equipment if it meets this definition:


Durable medical equipment is equipment that
is prescribed by your attending physician to be:
-medically necessary,
-not primarily and customarily used
for non-medical purposes,
-designed for prolonged use, and
-for a specific, therapeutic purpose in the
treatment of a sickness or injury.

I would say that based on the above there is a chance that if the doctor goes along with it I have a chance to get the insurance comapny to agree.

but, based on Okie's statement that Astericks are NOT medical equipment it will probably be hard to go in that direction - I'll post whatever I find out.

 

[XRpredator]

I only get 90%, but that's better than a swift kick in the butt. :D

 

[Okiewan]

I guess I should have said typical medical coverage, lol... go for it guys, you've been paying thru your nose for that insurance, might as well get some of it back if you can.

 

[endosports]

Originally posted by Okiewan
I guess I should have said typical medical coverage, lol... go for it guys, you've been paying thru your nose for that insurance, might as well get some of it back if you can.

Paying through the nose is an understatement!

Off the subject I just got a quote for the shop. 3500 down. Just to start up. :whiner:

 

[soquel]

Have a Dad thats a doctor! I'm lucky enough to have MD in the family. If your not as privilaged, you should try to find a doctor who rides at the races. A Doc that rides will better understand what you need and may diagnose you with "weak ligments".and if you really want to save so money, get sponsered by a doctor! My father helps support some racers by covering their medical exspenses.

 

[NVR FNSH]

soquel,
Is your dad taking resumes, er I mean new patients:) It would be a bit of a drive but I could be convinced to find a new doc.....

Brian

 

[WFO]

When I had ACL surgery, the insurance company OK'ed the knee brace. Since the doctor had already diagnosed my other knee as being a good candidate for ACL surgery (which I didn't want), I got him to tell the insurance co. that a second knee brace for the "good" knee would be a lot cheaper than the $15000 surgery. Tkhey evidently agreed 'cause I got two (total of $1600)

 

[Dennis Meyers]

After my ACL reconstruction in March I thought I was going to get a CTI2. I was told that I didn't qualify for a custom brace and my insurance company actually paid for an off the shelf Edge brace from Innovation Sports. When I found out that they were going to spring for a $525 off the shelf brace, I tried to get them to get me a pair of Asterisks instead(I would have settled for just 1), but the company who handles the orthotics for my Doc (Hanger Orthotics)didn't have an account with them(Asterisk) :(

 

[yzeater]

Yes!! I called my insurance company today. 100% coverage of all durable medical equipment. All they need is a doctor's note of necessity. What kinda doctor do I need to go to?

 

[2000SE]

not that i am dis-agreeing with you all because i think it is a good idea. i am going to check myself. The funny thing is that everybody is going to be running/riding around with brand new *'s or CTi's in the next couple of months!!! :yeehaw: :)

 

[endosports]

Originally posted by yzeater
Yes!! I called my insurance company today. 100% coverage of all durable medical equipment. All they need is a doctor's note of necessity. What kinda doctor do I need to go to?

You need to see an Orthopedic. :thumb:

 

[Camstyn]

Do you have to injure your knee first, to any certain extent, before your doctor will write you a note?

 

[yzeater]

No, but it's easier to get approval if you have a prior injury

 

[endosports]

Just tell the doc you hyper-extened you knee and have pain and you want surgury or a knee brace.

My doc suggested the knee brace because alot of guys are having surgery and have problems with arthiritis(sp).

Cost of surgery-5,000+
Asterisks-549

Just a little more cost effective for me and my insurance company. Tell them that this is best for you because you are going to continue to ride regardless.

BTW: Those asterisks work great and are adjustable for my case(hyper-extension).(just my contributionsplease don't quote me, and check your coverage before purchasing)