Hi,
I have knee cartilage problems & would love to try PRP. However, my
insurance will not pay for such therapy & I cannot afford the
$2,500 it will likely cost me for a self-pay treatment. I imagine the
cost is an obstacle for many people with joint & tendon problems
who would like to try this. Do you have any suggestions on how I might
obtain a reduced rate from the provider? Do you have a sense of when
insurance might cover this? Thanks!
Neil
Hi Neil,
Thanks for your questions. I know other people are in a similar situation. I have some thoughts for you about your knee and, as a disclaimer, I make them only to offer you another way of looking at your situation. I'm trying to help.
I'm going to push you a little on your statement that you can't afford the fee (and I think the cost is closer to $1000 to $1500). When it comes to healthcare, one of the first things people often say is, "My insurance won't pay so I can't afford it." This perspective seems independent of one's actual purchasing power. One of the side effects of health insurance is a subconscious sense of entitlement which is completely understandable. You've paid for coverage and you expect to have a benefit. But, health insurance is merely a contract that agrees to provide you specific benefits to assist you in paying for healthcare services. It does not replace an individual's own responsibility to take care of themselves.
Here are some things to consider to help you pay for healthcare services like a PRP injection.
- Analyze your "Latte money". My wife and I call frequent, seemingly low cost expenditures "Latte money". It's the money you would spend if you went to Starbucks everyday and bought a Latte for $3 or $4. Over a month that's about $80. In one year that's nearly $1000. If you find your "Latte money" and cut it out of your spending, you could very likely pay for a PRP injection.
- Call the provider and ask if they have any payment plans. Most do.
- Pay your self first. Out of your paycheck, transfer a small amount of money into a savings account. This works best if it is transferred before you get the check. If you could save even as little as $50/month, in ten months, you would have enough money that you could at least get the injection and if the provider has a payment plan, pay off the remaining balance in another ten months.
- Get a loan. While I'm not a fan of consumer debt (like buying a 65"plasma TV and paying it off for 48 months), we're talking about your body and your quality of life. Good health is the source of all personal freedom. It is truly priceless. If you have to borrow the money to get healthy, it will likely be worth every penny. Interestingly, many people will not think twice about spending $3000 on a 65" TV but shudder at spending that same amount on their health.
As for getting providers to reduce their fees, you certainly can ask. Most won't reduce their fees on these types of procedures because they take such huge reductions on the procedures that are covered by insurance. For example, a urologist I know of recently decided to stop performing kidney transplants and instead has decided to perform more vasectomies. Why? He was paid $500 to perform a kidney transplant and $1500 to perform a vasectomy. Kidney transplants are more work not only in terms of the surgery but the follow up care and carry more risk for both patient and surgeon. Boggles my mind. He's paid more to prevent life from starting that to prevent a life from ending.
Insurance comes late to the game on things like PRP. It's relatively new so until there is enough proof that the procedure will reduce the need for more expensive procedures and longer term care, insurance will sit on the sidelines. I have no idea when or if any companies will cover it.
Finally, PRP is not a panacea. You still need to go through a rehabilitative process which, if you have not tried this already, may help you. You may find, with the correct program, that many of your symptoms will subside. Managing a knee problem is a lifestyle shift. You have to not only do the right exercises, you also have to find the positions and activities in your daily life that overload your knee and remove them or alter them until your knee is healthy enough to tolerate those activities.
DK
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