A friend of mine was turn down for knee surgery and she is 74 years old. Her doctor said it was the first time he had ever had someone turn down for surgery. She had the knee ordered and everything was set for surgery. The doctor said to appeal because she does not have any other options. Does anyone have any advise on the appeal process. I have heard people say that there are incentives for physicans for alternative medicine but she has tried everything. The doctor does show much concern. I also heard lots of changes in medicare for surgeries like knee and hip. 

My 73 year old brother-in-law recently had knee replacement surgery and he is on medicare. He had it done at the Texas Orthopedic Hospital in the Med Center.

Who turned her down? 

Medicare turned her down according to doctor. 

Makes no sense. I had knee replacement 5 mo ago and am on Medicare but also have a supplement ins. policy. I am 70. 

I have heard you must try alternative treatments before surgery such as physical therapy, knee injections, braces ,etc however I am not certain of that info. 

Pollys Crackers I heard the some thing. The doctor said that she can appeal the decision. I had never heard anyone being turn down for knee surgery until this happen. 

I will say I had tried several knee injections, and had a brace a year prior to the surgery. It was during that time I heard that I was fulfilling the requirements for Medicare to approve the TKR. The doctor should have the scoop and direct his patient on the hoops to jump through. 

Yes, my Brother-in-law was the same as Polly. He tried many other things prior to surgery. Injections, physical therapy, water therapy, etc. He too has a good supplemental policy, I wonder if that has any thing to do with it.

His Dr is also a very experienced orthopedic surgeon and I am sure if he needed to send in a justification for it he would be experienced with that aspect. He had also done his hip replacement a few years prior.

That being said, the Dr did tell me after his surgery that he was getting to the point of not doing any more medicare surgeries because they weren't profitable any more. 

Her general physician had been giving her injections for about 2 years and now that she is seeing a knee specialist it might not count. I am so worried because she is 74 and medicare is not good to people 75 and over. Why or maybe the doctor(general physican did not know about it. i agree the knee doctor should be able to direct her in the right direction. Thanks. 

Her general physician had been giving her injections for about 2 years and now that she is seeing a knee specialist it might not count. I am so worried because she is 74 and medicare is not good to people 75 and over. Why or maybe the doctor(general physican did not know about it. i agree the knee doctor should be able to direct her in the right direction. Thanks. 

To actually answer your question and not just give you useless personal stories, the appeal process allows for three appeals. The first must be filed within 120 days of the denial. Call them for the details. It's not difficult as long as you are persistent and follow the time limits. Google can be your friend as a basic guide. 

Thank you everyone. I just wanted to know if anyone had been in the same situation and if they had any luck with the appeal process. We did get the appeal process started.