Delayed surgery. Achilles Tendon Rupture.
On August 18th, I ruptured my Achilles tendon but didn’t realize the severity of the injury. Two days later, I went to the emergency room, where they only did X-rays and referred me to an orthopedic surgeon. Unfortunately, that surgeon didn’t accept my insurance. On August 28th, I visited a different hospital and saw an orthopedic surgeon who confirmed the rupture but needed an MRI to assess the severity.
I was given a number to call to schedule the MRI, but I was told the insurance needed to approve it first, which would take 5-10 days. After five days, I called for an update, and they said they were still waiting for approval. I contacted the insurance, and they informed me that they were waiting for the doctor's signature. I then called the hospital, and they confirmed that they had sent multiple messages to the doctor, but he wasn’t responding.
After several delays and miscommunications between the hospital and the insurance, I finally had the MRI on September 13th, which confirmed a complete Achilles rupture requiring surgery.
However, after getting the MRI, I received a call from the hospital informing me that my insurance wasn’t covering my next appointment, which I believe was a pre-screening to prepare for the surgery. They later called again to let me know that the doctor had referred me to a clinic that accepts my insurance. Confused, I called the clinic to make an appointment, only to find out that they don’t treat Achilles tendon ruptures!
This is my first time dealing with a situation like this, and I wasn’t familiar with how the healthcare system works. I went to the second hospital because I researched and found that it was covered by my insurance. However, I later learned that I needed to go through my primary care doctor first. Since I had never visited the doctor where I live now, I didn’t know who my primary care doctor was or have any information about my health network.
I called the insurance again, and they informed me who my primary doctor was and helped me schedule an appointment. During the visit, my doctor assured me he would expedite my case as "extremely urgent" and would send the referral to the insurance for approval, which typically takes up to 73 hours. However, when I followed up with the insurance, they told me I needed to contact my health network provider (HNP). When I called the HNP, they informed me that I wasn’t in their system and that it would take at least three more days to process…
It’s now been over a month since the injury, and I am deeply concerned about further delays affecting my recovery. I understand that part of this is due to my unfamiliarity with the process, but from what I’ve learned, a complete Achilles tendon rupture should be surgically treated within 3 weeks. Every day that passes makes the healing process more difficult and may impact my ability to stand or walk properly in the future.
My question is: if the doctors knew this was an urgent matter, why didn’t they clearly explain that to me or communicate with the insurance that this surgery needed to be done as soon as possible? I understand that my lack of knowledge may have contributed to the delay, but I believe it is the doctors' responsibility to fully explain the seriousness of the situation, which they failed to do. Additionally, my primary care doctor mentioned that it would be fine to operate on my Achilles within 2 months, but all the research I’ve done suggests otherwise.
Who is responsible for the delays?
Are the Doctors responsible for not explaining to me that is best to operate within 3 weeks?
Should I keep waiting indefinitely to get the surgery done?
If I experience complications after the surgery due to these delays, would I have grounds for legal action?
Thanks for your advice, opinions.
submitted by /u/BikinginNYC
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