Dale Says

November 14, 2006

Does Health Care Insurance Cover Allograft OATS?

Filed under: Knee Surgery — Dale @ 2:00 pm

Be sure to check with your health care insurance company before you agree to have this procedure done. Some cover it; others do not; and still others have stringent criteria that must be met before the procedure is covered.

My insurance company (CIGNA) will cover it if several conditions are met:

CIGNA HealthCare covers osteochondral allograft transplant as medically necessary when ALL of the following criteria are met:

Symptomatic and debilitating focal chondral lesions of an articular surface of the knee are present. Previous medical and/or surgical management has failed. The patient is not currently a candidate for total knee replacement.Other insurance companies have different criteria. Some specify the site and size of the damage to the knee, and some even specify that the patient’s age and even body mass index.

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