This is not meant to be a political post. It’s meant to elucidate how serious ACL surgery is. This is the stuff your surgeon won’t tell you about.
I tore my ACL when I was 24 years old, I had surgery 7 months later briefly after turning 25, 18 months later (now) I’m 26 years old.
Due to ObamaCare I was able to be insured under my mom until I was 26 years old. This is one reason I had the surgery when I did: A year or two later may have been a poor decision to have the surgery because my mom’s insurance is unparalleled.
Now, 8 months into being 26 years old, I still can’t get health insurance. Why? My ACL history.
Let me correct that, I can be covered, but here’s how.
I rarely go to the doctor. Other than my ACL issue I’ve visited a physician maybe once in 6 years. So, I applied for a $4000 deductible plan, with a monthly premium of $90, and no coinsurance after the deductible. The plan is the “I’m fucked health wise but not financially.” The if I got cancer, I’d be covered plan. I was denied coverage, but because I had health insurance within the last 60 days I was, by law, eligible to be covered. The catch though is the plan I could be covered by is essentially up to the insurance company.
Here’s the new plan I was offered: $4000 deductible…$450 monthly premium…35% coinsurance on everything. So, yeah, I’m not going to pay for that.
Because that application was within 12 months of my surgery I figured I’d try again. Last week, 18 months post op., I applied for a $6000 deductible, $135 monthly, 0% coinsurance. Same idea. Need an amputation? Covered.
This time I was approved! I must have answered 100 questions on my application, and other than 4 or 5 about my ACL I answered “No, I don’t have an issue with that” for all others. So I felt good I would be approved, and I was.
Of course, there was a kicker. I was approved, but at a higher rate. I thought this might happen. I was thinking maybe an extra 100 bucks a month or something.
The insurance company I applied with puts each person into a tier. Tier 1 and you’re golden. You’re like an 18 year old. It seems healthy people under 30 or so are pretty much guaranteed Tier 1 or 2. The highest tier is 5. I’d assume for former cancer patients, diabetics, heart attack history, etc.
I was approved…at Tier 5.
Tier 5 changes my plan to: $6000 deductible and $421 monthly premium. I was also approved at some other plans. One was a lesser deductible at $650 a month, my favorite was another at $2400 a month.
My offered plans:
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I’m either denied health insurance or qualify as the riskiest candidate possible.
For all the people thinking ACL surgery is some run of the mill deal, that you get cut, wake up, and are off on your merry way, you might want to take note in how serious the insurance companies take it. They have obviously priced me out of the game. I even had a 10 minute conversation with one of the insurance nurses where I was asked over and over again, “So you have no complications now? You’ve been cleared a year? You’ve had no follow-ups since? Do you have any restrictions now?” None of which is an issue for me. Made no difference.
Here’s to praying til 2014.
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nlatimer
June 17, 2013
The whole thing infuriates me and just makes me SICK.
dn
July 22, 2013
I don’t understand the thinking…like a previous ACL injury is going to make you more likely to get cancer or diabetes or something?? That’s ridiculous!! I’m sorry you’re going through this.
reddyb
July 23, 2013
From what I’ve heard in the insurance community the thinking is someone with my history has a greater chance for arthritis, thus further knee surgeries, particularly a knee replacement. Because of this, they don’t want to take the chance.
Thanks for the commiseration.
Dmytro Skrypka
September 20, 2015
I had my surgery 2 month ago and got to this post only now. I’m from Ukraine and insurance here is another story. They only cover surgery but i have to pay for prostetics myself so i paid about 500 usd.
In hospital i met some foreign guys who came to have this surgery because its so cheap. Local currency dropped 3 times because of crisis and now its even cheaper in usd. I would guess if you chose best clinic here you would pay 3000 usd maximum and that would include surgery and meds and 1 week in hospital. Maybe meds a bit more because some are not produced locally. For another 2000 usd you canrent an appartment for 3 month and pay for daily rehab or something.
Knowing that this cost 50k usd in US shocked me a ton. Do i understand the cost correctly?
I’m reading your posts on rehab. Good advice, thank you.
reddyb
September 22, 2015
Hey Dmytro,
Here is a cost breakdown by someone else, totaling ~$69,000, and as he says, that’s actually not including everything. He didn’t include MRIs or physical therapy. That could easily add a few more thousand. http://calv.info/the-cost-of-an-acl/
One of the things with the States healthcare is you never really know how much something costs, unless you say “I’m paying with cash.” Then you can usually get a very good idea how much things are actually, and usually it’s way, way less than what is paid with insurance. ACL stuff here is probably ~$10,000 if one were to pay in cash. With insurance? Impossible to know. But many tens of thousands is a common number.
(I’ve literally said to an MRI place, “How much will it be?”
“Oh, we don’t know. That depends on this, on that…”
“I’m paying with cash.”
“$400.” Which is a very low number compared to what most are used to hearing. But most don’t pay with cash.)
People leaving the States for medical procedures is something I’m hearing more and more about. Many are going to Mexico for dental work, being in San Diego I actually have clients who do this, and I wouldn’t be surprised if orthopedic work started getting “out sourced” as well.
In a country with the wealth and resources of the United States, the fact people are traveling, often flying, to other parts of the world to get medical care, rather than their own city or state, is pretty embarrassing in my opinion. Things have improved here with the latest administration, but we still have a lot of work to do, and it’s a never ending political battle to make progress on this front.