← Return to Swelling and stiffness, 3 years after total knee replacement

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It's interesting what Medicare will cover. I had to sign a form specially informing me Medicare would not cover it, but with my history what choice did I have. I figured I would have nothing to loose by appealing and the very least I would have the satisfaction of at least getting them to read the stack of documents I sent. I sent off pages of documentation which included my allergy history and documentation of previous allergy tests (covered by Medicare) and finally got my doctor to write a "letter of medical necessity" based on my allergy history. This took some doing as his office told me Medicare would not cover this test so it was a waste of time. In truth I am shocked that Medicare will not cover this test because allergic rejection is not rare. I am beginning to wonder if the surgeon doesn't want tests like this done as it would discourage surgeries. This entire gorgeous brand new hospital w is designed inside and out like a 4 star hotel is for orthopedics only and has multiple surgeons; joint replacements are taking 3 months to book. Lack of business is not an issue. This is not a major metropolitan area- it's in the city of Ozark on the outskirts of Springfield, MO a mid-size city. In the appeal I included copies of the blood allergy test showing my positives and explained that because of results I could not be a candidate for a knee replacement, plus included documentation of the alternative ceramic implant which many are rejecting and copies of the class action lawsuit. In a personal letter of appeal I also wrote up how much money Medicare would be saving because I would not be having a knee replacement plus if I had not had the test and gone ahead with the surgery the expense of future surgeries would be massive. I am not sure they cared about my pain or suffering, but I do because after rejection and removal I would be left completely crippled without a knee joint. I sent all this off 3 weeks ago and checked that it was received. As expensive as this surgery is it seems this test should be mandatory.

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Replies to "It's interesting what Medicare will cover. I had to sign a form specially informing me Medicare..."

@gardeningjunkie I will be very interested in hearing the results of all of your efforts. This was done to try to get them to pay for stem cells or just the metal testing? If not for stem cells I would think if a person shows definite sensitivity to the metals involved that it would be to their advantage to pay for stem cells too. Maybe they will eventually if enough people have it done and it is successful in the majority of the time, which I think it is now. I think it is still considered to be almost experimental.