Thread: ACL surgery coming up w/ unknown outcome

No noteworthy news on my end, started hanging my leg off my bed to work on extension and it's really coming along nicely.

I did get my first "pre" bill today though. Since I don't recall seeing it in other ACL threads, and I know a fair amount of mags don't have insurance I thought I'd add some $ figures to the thread. Figured it could help people ballpark what kind of wallet damage they are looking at. This is the "this is not a bill" letter from BCBS. My insurance is pretty basic... I only pay ~70/month on an individual plan. I have a $1000 deductable, and half of that was taken by my MRI.

SO:

MRI - $501 and some change
Surgery, this is what was charged BCBS by my doc.
Total billed charges:$4,788.00
Minus BCBS payment of $3,579.69
Leaving an allowable provider charge of $1,208.31
Minus a plan payment of $565.45

Leaving me with owing $642.86

This is considerably cheaper than my previous knee surgery... I have the itemized charges from that and was expecting this one to be closer to $10k.

Does this seem inline with what others have paid for just an ACL?

Glad to hear things are going well. No idea what mine cost since it was all covered by my health coverage and I never got copies of any bills. I just moved to New York for a new job that also has good health benefits, but it was strongly recommended to me to have it done before moving because the new plan may not have covered a pre-existing condition or I'd have to wait for a period of time before it would be covered.

I have paid about $1,300 so far and will probably have to fork out another $4-500 to the doc and might have to pay up to $1K for my braces (that were given to me by an in-network doctor, but were provided by an out-of-network vendor).

Mine totaled out to be about $11K, just ACL, like yours.

$250 out of pocket and that was it.

Totaled out about 16k (after surgery brace only), 4 hours in outpatient surgery. Mostly picked up by insurance, but I did have to pay a 2500 deductible. Hospital gave me a discount for paying in full, but only after I asked. Healthcare is such a scam.

I've only seen the doctor bill so far. It was $13.5K. I still haven't seen the ER bill, the overnite in the hospital after surgery bill and have been going to PT for over two months, got free drugs and have only dropped my own coin for orthobionomy sessions once a week. And got a check every two weeks. Comp roolz.

my surgery was somewhere around 10K. but, if you include brace, drugs, PT sessions, Dr. Appts etc, we are probably near 25K. I kept all the bills, I do want to add them up sometime. I am fourtunate to have excellent insurance, i have really only had minimal co-pays and I had to pay $250 or so for my brace, only 80% was covered by insurance.

Well, now I'm really confused... Had lunch with my boss today and got some other news $$ wise. (I met my doc via my boss, they play soccer together and have a company together as well)

Boss was telling doc what I was telling him about costs involved in my first knee surgeries on my left knee and how I was expecting this ACL surgery to be a LOT more than $4700. Was then informed that the hospital billed my insurance $33,000 for the surgery!!!! Was also told that insurance co's then turn around and pay the docs/hospitals what they feel is reasonable regardless of the costs incurred. Anyone have any similar experience with this? I don't know what to believe at this point, but I wouldn't put charity past my doc. He has done free ACL surgeries for other players on their soccer team.

you do not want to have a post-op infection. the bills to treat that are still coming in - but over $10k alone on that (not counting any of the surgery stuff).

out of pocket for me is probably going to come in around $3500...

I'm off crutches now. Can walk w/o a limp if I work on it, but it gets stiff, so if needs to loosen up before acting normal. My ROM is pretty decent. Can get it straight no problem and am bending it to probably ~110 degrees. Haven't been to PT yet either. Hoping to talk to my doc on Wed. and see where we are with that.

Glad to hear you're healing up. Thanks for posting the $$ breakdown. I've heard that insurance co's and hospitals negotiate over the prices paid in the past, but not sure to what extent it goes on. I did a little somethin' somethin' to mine rolling back earlier this year and have really noticed the instability in it, but not really insured right now so have been putting it off.

Where do you train at?

Originally Posted by Crystal_Mt_Dreamin

Glad to hear you're healing up. Thanks for posting the $$ breakdown. I've heard that insurance co's and hospitals negotiate over the prices paid in the past, but not sure to what extent it goes on. I did a little somethin' somethin' to mine rolling back earlier this year and have really noticed the instability in it, but not really insured right now so have been putting it off.

Where do you train at?

I appreciate the kind words! I see the doc this morning, so hopefully I'll have a progress report later. I'll see him at my office instead of his, that way I don't have to pay for a follow up visit. Gotta love connections!

I train at Crawford's MMA: http://www.crawfordsmma.com

If you watch the free UFC fights tonight on Spike, Rob Kimmons is the first fight, he's from my gym. It isn't supposed to be televised, but if something good happens, they'll show it!

Saw the doc this morning and got 2 thumbs up from him. He didn't mention anything about PT and said what I'm doing now is good enough. My ROM is exactly where he wants it as is swelling/stability etc... Said next milestone is 16 weeks, then I'm past the "weakened ACL" stage of healing. Also said that I would never get my foot on my ass again, which put me off a little. Said the graft is tight enough it will allow it to get close, but not touch. I'm to keep on my ROM stretches and leg lifts, but no plans for PT right now...


Thoughts from the peanut gallery? Not sure I agree with the flexion diagnosis... but he's the doc. What say ye?

^^^^
interesting on the flexion/explanation. I've heard it's just a matter of time (year+ sometimes), but everyone I know has gotten there. Sounds like he's saying the graft is so tight that it won't happen? Is that true? Haven't heard that one before. Not sure if that's bad - better for the graft to be tight, than loose I would think.

My left knee won't get there, but I had some other stuff happen to it too. I'm not expecting it to get there right now, but I would like to to get damn close, otherwise, Ju Jitsu is going to suck...

He also said no squating, no lunges, no heavy lifting ect... just take it easy, walk and do normal stuff. Main worry is that now I'll enter the "I feel fine!" stage and eff it up while it's at it's softest. Especially knowing that I'm an athletic guy and want to get back to playing shape asap.

I think his take on PT is interesting. In one regard, I like it, if I'm getting the results I need and am doing my exercises, I don't need to pay someone to say rah rah, good job. In another, it doesn't feel traditional, and you always question things that aren't the norm.

I do like the fact that he's a proponent of don't waste the money if there is no need.

In the future (~6 months out) he said they might remove a staple from my tibia that was helping hold stuff together just post op. Said it would probably stick out a bit as the long term swelling goes down and in my sport a kick to it would probably hurt like a bitch.

I've heard thru the grapevine Kimmons is pretty good, but haven't seen any footage.

Re: the 'I feel fine' stage, that's always been my downfall as well. Now that I'm older I usually take longer than I should to make sure everything is 110%.

Here's something that will make you feel better as you go thru all of this - be glad it's just ONE ACL you had done. My high school buddy/college roommate blew out his knee in HS nationals. Went in for surgery...woke up and they'd done the WRONG knee! He had to go thru rehab on that one, than once it was OK get the proper knee done, rehab that. I've been with him on two separate occasions since when he's blown out one or the other (both years apart so there was time to heal).

I'm 14 weeks out and asked a similar question at my last checkup. He said it wasn't impossible and that there are other factors besides the graft that can limit flexion, things like the fluid sack above your knee and p tendon healing. I guess he was trying to say that with time it will be normal and wouldn't feel tight. I started PT right after the surgery but did the same things you are doing. They weren't that helpful until I was walking alot (~3-4 weeks). They corrected my walking and gave me exercises to get back to normal walking without thinking about every step.

Originally Posted by Crystal_Mt_Dreamin

I've heard thru the grapevine Kimmons is pretty good, but haven't seen any footage.

Re: the 'I feel fine' stage, that's always been my downfall as well. Now that I'm older I usually take longer than I should to make sure everything is 110%.

Here's something that will make you feel better as you go thru all of this - be glad it's just ONE ACL you had done. My high school buddy/college roommate blew out his knee in HS nationals. Went in for surgery...woke up and they'd done the WRONG knee! He had to go thru rehab on that one, than once it was OK get the proper knee done, rehab that. I've been with him on two separate occasions since when he's blown out one or the other (both years apart so there was time to heal).

That would suck.... royally. They asked me a bunch of times "we're fixing the right knee correct?" just to make sure. Shaved the knee. Doc came by, initialed it to make sure. They did all of that before putting a mL of anything in me.

For Rob - search Rob Kimmons on youtube, he has some decent highlights out now. His first UFC fight against Yundt is on there, and if you click his "pro highlight reel" vid, his fights against Yunker and and Eastman are there as well.

Originally Posted by Theodore

Saw the doc this morning and got 2 thumbs up from him. He didn't mention anything about PT and said what I'm doing now is good enough. My ROM is exactly where he wants it as is swelling/stability etc... Said next milestone is 16 weeks, then I'm past the "weakened ACL" stage of healing. Also said that I would never get my foot on my ass again, which put me off a little. Said the graft is tight enough it will allow it to get close, but not touch. I'm to keep on my ROM stretches and leg lifts, but no plans for PT right now...


Thoughts from the peanut gallery? Not sure I agree with the flexion diagnosis... but he's the doc. What say ye?

Weird to me. PT gave me exercises on equipment I would not have at home. Personally I think PT was key for my knee.

16 weeks for past the weakened ACL????? Not from what I have read about vasculazation of a cadaver graft. That sounds wrong.

Yeah, my doc told me I would never sit on my heel again. Was able to as of 6 months, after I broke through a bunch of scar tissue. Again, PT was key is keeping scar tissue to a min. I bet you will be able to as your background will help in recovering the knee.


Everyone's doc is different. Glad things are going well.

B-dub - how long were you thinking? That is 4 months out from op. My understanding was that the allograft added ~ 1 month to recovery time due to the revasculazation issue.

^^^^^

It really depends on the person, but my doc had said 6-12 months for the allo re-vascularization. And yeah, I snapped that fucker like a twig at 7 months. Even if you feel strong the graft may not be.

I got the okay to do squats/lunges somewhere around 3-4 months from the doc and the PT, but only with ~ half body weight.Just focus on lower weight more reps for the first 3 months. The biggest advantage for me with the PT was the propreception and plyo work I did that I probably wouldn't have if I hadn't been going, even if it was only once every two/four weeks after the second week.

As for flexion, at 16 weeks you should have all of your functional flexion/extention back, the rest will come back slowly if you continue to work it but it can be really slow. It kind of depends on just how tight the doc put in the graft. I'm 18 weeks out on the re-fix with PT autograft and I can just barely get the heal to ass if my shoes are on, but it's still uncomfortable at the last ~5 degrees.

Originally Posted by Theodore

Saw the doc this morning and got 2 thumbs up from him. He didn't mention anything about PT and said what I'm doing now is good enough. My ROM is exactly where he wants it as is swelling/stability etc... Said next milestone is 16 weeks, then I'm past the "weakened ACL" stage of healing. Also said that I would never get my foot on my ass again, which put me off a little. Said the graft is tight enough it will allow it to get close, but not touch. I'm to keep on my ROM stretches and leg lifts, but no plans for PT right now...


Thoughts from the peanut gallery? Not sure I agree with the flexion diagnosis... but he's the doc. What say ye?

I'm at 140 and going for the ass kick, T. I wrench on it with wall slides - lay on floor, ass about 18 inches from wall, put foot up the wall and bring it down til it quits, then I throw a belt or towel above my ankle and pull down til it hurts good and hold it there. It's a great method to keep it stretching. Remember, though, I am now 13 weeks post-op.

On another note; I might have some additional repair needed. A nerve got crossed when my knee was done that radiates a worsening pain from my ankle along the tendon to my big toe when I flex my foot toe downwards. If it hasn't cured itself in two months...I dunno, but it sounds like something will have to get re-routed.
Going in for my rotator cuff MRI next week.

Mofro... that is my #1 concern. I do NOT want to do that! I just need to make sure to take it easy and not push it.

ROM - Splat, thanks for the idea, I'll try that. I'm "lightly" pushing it at this point. I get to the pain and hold it for 30 seconds and repeat. I don't want to crank on it and screw something up. My doc also said that more flexion will come as a bit of the internal swelling goes down.

And Splat.... goddamn... you are a Dr's wet dream. haha Keep yo head up!

Originally Posted by Theodore

B-dub - how long were you thinking? That is 4 months out from op. My understanding was that the allograft added ~ 1 month to recovery time due to the revasculazation issue.

Going to echo what Mofro said to the T. 6-12 months is what I was told too.

The worst time for your knee is when it all feels great about 4-6 months in. Then you start doing things you question, but do it anyway and then, maybe ........pull a Mofro.

Now keep in mind, he has way stronger legs than his knee was and I think that this strength overrode the strength of Mofro's graft. I on the other hand have snowboarder legs. Skiing works the legs so much more.

Just don't get crazy when it feels good. That simply means you are finally healing without the pain. BUT YOU ARE STILL HEALING.

My 2 cents for the day.

Oooo oooo! New bill from BCBS!

That $33k I said my doc billed... yeah, it hit. So, totals on that are...

Total billed - $31,881.92
minus BCBS discount of $13,071.58
leaving a charge of $18,810.34
BCBS covers $16,951.70 of that

Leaving my new balance at $1,858.64.

Yippee! Fack.... that trip to the Bahamas this winter w/ my girlfriend is starting to look a little iffy. Grrrrr.

*edit* Spoke w/ BCBS. These are separate. First was doc's bill, second is the hospitals.

Total owed now is $2501.50. I'm assuming I have a few more coming.