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Presentation at AAOS Meniscal Tears in Relation to Medical Insurance Type

Friday, March 14, 2014

Leveling the Playing Field - OIC strives to level the playing field for all children

A recent Orthopaedic Institue for Children study shows that undersinsured children may have to wait 3 times as long for required orthopaedic surgery than children with full insurance. Children who experience delayed care are 5 times more likely to have lifetime residual effects from their injury.

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Presented by Richard Bowen, M.D.
American Academy of Othopaedic Surgeons
March 2014
Meniscal Tears in Adolescents with Anterior Cruciate Ligament Rupture:
Relation to Medical Insurance Type

We found that adolescent patients with managed MediCal insurance (California's version of MediCaid) who tore their ACL had a five times higher risk of additionally having an irrepairable meniscal tear at the time of their ACL surgery as compared to patients with commercial insurance. Patients with managed MediCal also had significantly longer times between their injury and surgery (three times).

We didn't look at the reasons for this, but there could be many:
1. Patient's not seeking medical attention because of financial / cultural reasons
2. Delayed referral to a specialist by their primary doctor
3. Delays in getting an appointment with a specialist
4. Delays in getting MRI's authorized and approved
5. Long wait times between surgery suggested and scheduled (not enough surgical OR availability with the specialist at a hospital approved by their insurance company)
6. Delays in getting the surgery authorized by the insurance company
7. Patients being diverted to another specialist at another facility by their insurance company once surgery has been suggested

The physicians at OIC think that, by having our own Ambulatory Surgical Center (ASC) which is contracted with the managed MediCal groups that insure our patients, we can:
1. Offer timely surgery dates for patients at our own ASC
2. Decrease delays in obtaining authorization for surgery
3. Decrease the number of patients diverted to another specialist at another facility by their insurance company.