Need advice: seeing knee specialist about a previous injury

[xboxist]

I'll keep it simple.

I destroyed my knee in high school on some freak accident. It tore some ligaments and separated some tendons. Apart from the emergency room visit, I remember having a couple of doctor visits, and ultimately, I never had to have any sort of surgery or even much rehab. It took about 3 months before I was able to start putting pressure on that knee, and a full 6 months before I could walk pseudo-normal again.

That was 10 years ago. Now that I've underwent a mission to try to get back in shape, I'm finding that my knee is clearly not properly healed and is completely impeding my progress. I can't do lower-body workouts with that knee, and even low-impact stuff like cycling causes the knee area to inflame and deem it unusable for that next day. I'm talking super-mega pain and I can't even fully extend my knee once that happens.

SO... I want to get it looked at. The obvious problem presents itself. Do I walk in there, give an honest explanation, and probably fully risk my insurance not covering it because it's a previous injury (and thereby voiding the whole idea since there's no way I could pay for any significant amount of money), or do I make up some bullsh*t story about how it has just started hurting or something? And thus, probably burning in Hell at a later date.

No one can afford healthcare. I don't want to screw the system, but I also don't want to be inactive my entire life because I wasn't properly treated/followed-up with in the past. What would you do? How should I approach this?

 

[GoingUp]

Well are you willing to risk getting caught for fraud? Because thats what youd be committing.... insurance fraud.

 

[ggnl]

Prepare to get flamed

 

[JoLLyRoGer]

I would tell the truth. I'm not too sure you're insurance wouldn't cover it. I recently underwent surgery to correct a bone spur in my ankle which was also a pre-existing condition. I had not one problem getting approval from my insurance carrier to get the surgery. Best advice is to talk it over with your Doc, explain exactly what you posted here and let them determine the best course of action. What you don't want to do is put this off until the condition worsens. Clearly after all this time it is not going to just go away.

 

[stonecold3169]

I bet it will get approved. Your insurrance thinks about it like this: If your knee gets worse, you get less exercise (you already are). You get less exercise, you get fat, and get more health problems, which in the long run is far, far more expensive to them then just fixing you up right now.

Good luck!

 

[rahvin]

Preexisting conditions on most medical polices require 1 year without any treatment, being that it's been 10 years they won't be able to nail you on a pre-existing condition.

 

[Landroval]

I went to a sports doctor about an old injury and my insurance covered an MRI, physical therapy, etc. If I had lied, not only would I be committing fraud, but he would have had a harder time diagnosing and treating it. Making up a more recent injury is just going to waste time and money.

 

[HamSupLo]

you should have no problem getting surgery. I wouldn't worry about insurance. Just tell your doctor that your knee is screwed up and he'll put in the paperwork no questions asked.

 

[Uppsala9496]

Pre-ex is between 6 months and one year depending on the group insurance plan.
You have no worries.
(I used to underwrite group medical insurance, so I am very familiar with pre-ex questions on applications)

 

[squeeg22]

A doctor will be able to tell that it is a preexisting condition due to factors like internal scar tissue, deterioriation, etc. Just be forthright about it from the start. Or, just call up your insurance company and get a straight answer about coverage before you go in.

 

[sixone]

First of all, insurance fraud carries some pretty stiff penalties. If the amount is high enough, it can be considered a felony. You better think long and hard about that before you do it.

Second, most insurance companies have a standard pre-ex policy: If you were treated or had symptoms for this specific condition during the three months prior to the effective date of your insurance policy, they won't pay for that condition for 12 months. After that time is up, they will cover any costs for treatment, subject to deductibles, etc.

In other words, if you've had the same medical insurance for more than one year, pre-ex will probably not be a factor in any case. All it takes is one phone call to your insurance provider to find out.

I find it fascinating that the only options you considered were not getting care or committing fraud to get it. Is that really the persona you want to be broadcasting here?