Insurance Insight: Carpet To Help Keep Knee Surgery Covered? - NewsChannel5.com | Nashville News, Weather & Sports

Insurance Insight: Carpet To Help Keep Knee Surgery Covered?

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ROCHESTER, N.Y. (Ivanhoe Newswire) - ACL injuries have increased 400 percent in teens and adolescents in the last ten years. They're also on the rise among baby boomers. To make sure you don't have to pay out-of-pocket to fix the injury, doctors are using a new tool to show surgery works.

A few months ago, Chris Spinelli tore his ACL in a soccer game.

"I planted and he ran into me and hit my knee at just a funny angle and I just went right down," Chris Spinelli told Ivanhoe.

Dr. Mike Maloney said surgery gets patients back to near-normal, but healthcare reform may change whether it's covered by insurance. Doctors will soon need to prove the knee surgery helps.

"There's a huge challenge that a lot of the procedures we do have not gone through that rigor and therefore, third party payers may say, ‘we're not going to pay for them anymore'," explains Michael Maloney, M.D., an Orthopedic Surgeon at the University of Rochester Medical Center in New York.

That's where the gait-rite system comes in. This 26-foot carpet contains sensors to assess gait after injury and again after surgery to show how patients are doing.

"We will have seen that their gait has been restored to what we consider normal and safe and allow them to progress," Dr. Maloney said.

It also identifies those who are not recovering well. It's good for patients, but the system is really a way to curb potential problems with insurance coverage when new healthcare laws go into effect.

The surgery worked for Chris, but without his insurance.

"There's just no way I would have been able to do the surgery and then I'd be like, ‘what am I gonna do'?"  said Spinelli.

He hopes this research will save people from asking that question in the future.

Of the roughly 200,000 ACL injuries a year, nearly 100,000 of those are fixed with surgery. The cost of surgery ranges from 20,000 to 50,000 dollars, followed by months of rehab. It typically takes six to twelve months after surgery to get back to normal activity.

RESEARCH SUMMARY

BACKGROUND: The anterior cruciate ligament, also called the ACL, is located in the middle of the knee and it stops the shin bone (tibia) from sliding in front of the thigh bone (femur). In an ACL injury, there is either a complete or partial tear to the ACL or the ligament has been overstretched; this can happen if someone is hit very hard on the side of the knee, overextends the knee joint, or changes direction quickly while running, turning, or landing from a jump. ACL injuries are often considered sports injuries because ACL tears are linked to sports like basketball, soccer, football, and skiing. (Source: www.nlm.nih.gov)

SIGNS: Some symptoms that may signal an ACL injury include:

  • Knee swelling within 6 hours of the injury
  • Pain in the injured area, especially when putting weight on it.
  • A popping sound at the time of the injury. (Source: www.nlm.nih.gov)  

TREATMENT: ACL injuries can be very painful and can prevent people from carrying out their usual activities, especially if they are an athlete. The two main treatment options for this type of injury are rehabilitation therapy or knee surgery. Rehabilitation therapy may involve using a knee brace, exercises to help the knee's range of motion, and muscle strengthening and stability exercises. Sometimes the rehabilitation therapy alone is enough, but depending on the damage to the knee and the individual person's needs, surgery may be necessary. Two common procedures for ACL injuries are arthrocentesis, where a needle is inserted to remove excess fluid from the knee joint which will lower swelling, and surgical reconstruction, where a piece of tendon from another part of the leg is put in place of the ACL. (Source: www.mayoclinic.com)

INSURANCE COVERAGE: Many times treatment for sports injuries are not covered by insurance or are only partially covered, leaving large bills for the patient to pay. Proving the necessity of correcting the injury with surgery or some other form of treatment is key in getting insurance to cover some of the costs. Some universities have even begun to offer insurance coverage for their athletes because of the issues with excessive costs and continued injury. (Source: www.nytimes.com)

FOR MORE INFORMATION, PLEASE CONTACT:

Karin Gaffney Christensen, Public Relations and Communications
University of Rochester Medical Center
karin_christensen@urmc.rochester.edu
(585) 275-1311

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