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    Thread: Health Insurance question?

    1. #1
      Dzone's Avatar
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      Default Health Insurance question?



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      I tore my right rotator cuff benching years ago then tore it way worse on new years eve throwing wood and I am pretty damn sure It is going to need surgery.. I was able to get a free MRI last month, thanks to friends at the MRI place, without seeing a doctor. 3 torn tendons and a torn labrum. I did not have any insurance coverage until today. Just today I bought PPO health insurance that will cover me for orthopedic surgery etc. I have made an appointment with the surgeon on March 15 and am 100% certain he will tell me my shoulder needs surgery. But I know he will need another MRI with contrast. My first MRI was without contrast and surgeons prefer MRI with contrast. But I am going to show him the MRI I got last month. .

      So do you guys think this new Aetna PPO insurance will cover this injury or will they find out I had that MRI taken previously and refuse me coverage due to pre existing?
      If I am not covered, I dunno what the hell Im going to do. Take out a loan for surgery? Get my surgeon friend to cut me a deal? Atm I am too damn prideful to be asking a friend to cut me a deal on shoulder surgery. lol
      Im really hoping this insurance will cover me. What do you think?
      Thanks!!!

    2. #2
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      Default Re: Health Insurance question?

      Do not show the old MRI to the doctor. He will report it as an injury before you had insurance. Pretty sure insurance will not cover it. When you talk to doctor and this is important, the injury happened after you got insurance. You should be ok

    3. #3
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      Default Re: Health Insurance question?

      Quote Originally Posted by dirtwarrior View Post
      Do not show the old MRI to the doctor. He will report it as an injury before you had insurance. Pretty sure insurance will not cover it. When you talk to doctor and this is important, the injury happened after you got insurance. You should be ok
      Thanks! Yep, I was thinking the same thing. But Crap. I already told them I had an MRI done when I made the appointment & they told me to bring the MRI. Thats the surgeon I would prefer to do the surgery. Maybe we can start the case from scratch and order new MRI. plus, my MRI was done in an open air MRI machine, not the tube, and I think tube MRIs are preferred.
      I guess all I can do is be up front with the doctor and tell him I havent seen any previous doctors and that I was able to get the MRI done without needing a script. Dang it I should have gotten this insurance sooner.
      The radiologist did produce a written MRI report.

    4. #4
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      Default Re: Health Insurance question?

      Dont some insurance companies cover you for pre existing?

    5. #5
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      Default Re: Health Insurance question?

      From my experience, if you can avoid surgery, do so. I had both rotator cuffs damaged back in 2010. Screwed up and had one repaired while I let the other one repair itself, as it has in the past. I have NEVER gained strength in any of my shoulders since. I can only perform shoulder presses on the Smith machine, never dumbbells.
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      Default Re: Health Insurance question?

      Quote Originally Posted by Dzone View Post
      Dont some insurance companies cover you for pre existing?
      maybe or maybe not. i would say better to er on the side of caution. you could always tell them they miss understood you and that you told them that you needed an mri for sure
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    7. #7
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      Default Re: Health Insurance question?

      Quote Originally Posted by TheChosen1 View Post
      From my experience, if you can avoid surgery, do so. I had both rotator cuffs damaged back in 2010. Screwed up and had one repaired while I let the other one repair itself, as it has in the past. I have NEVER gained strength in any of my shoulders since. I can only perform shoulder presses on the Smith machine, never dumbbells.
      I hear ya. I really want to avoid surgery if at all possible. Quite a few years ago, I had the ortho surgeon tell me that my shoulder was so beyond repair that the only solution for it was surgery. well, I never had the surgery and I got back to benching dumbbells and doing overhead presses. But this recent injury seems to really be a doozy. Even if the shoulder surgery doesnt work, it cant be worse than it is right now. Surgery might be a gamble, but If this doesnt heal, I may have no other choice except just live in pain the rest of my life. Ive dealt with a lot of pain over the years, but when you have a deep throbbing pain that doesnt stop and is 24/7...Pain that doesnt go away after woofing down 800 mg ibuprofen and 1,000 mg of tylenol.

    8. #8
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      Default Re: Health Insurance question?

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      After spending a few hours reading up on this subject, and a few hundred youtube videos, Ive decided I am NOT going to have surgery. There are far too many studies out there that show that 6 months of exercise therapy was as effective as surgery. I got the book on shoulders by dr kirsch and I highly recommend it. I stopped taking nsaids and tylenol and am still going to meet with a surgeon on monday just to get her perspective.

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