Re: Hip replacement advice

[Guest guest]

I'm not familiar with this particular HMO organization or the

contract you have with them. If his coverage is through his employer

could they go to bat for him? Is it that his surgeon says he needs

hip replacement and has asked for approval but has been denied? Do

they say why? You say he " apparently " needs a new hip? Is there

some doubt? What is his diagnosis? osteoarthritis, or something

else? Is he in a medicare HMO? There is probably an appeals process

written into the HMO contract so familiarize yourself with that.

Sounds like the legal avenue may be necessary and good luck with

that.

As to choosing the hardware: choice of surgeon is really as or more

important than choice of hdwre (I know, I know - with an HMO your

surgeon choices may be limited). You want a surgeon who has done

lots of surgeries on people like your father-in-law. surgical

technique and expertise is very important, even more than what brand

or kind of joint is implanted. A good surgeon can make any

prosthesis work and work well.

I advise devoting maximum energy getting to the bottom of the reasons

for his excruciating pain and the HMO denial of coverage for this

very expensive medical procedure and less time worrying about which

prosthesis is implanted.

I also have coverage through an HMO and have been very pleased with

my care. I didn't have much in the way of surgeon choice but both of

my THRs have turned out very well. Luck of the draw I guess. Best

of luck to you and your father-in-law.

> My father-in-law is in excruciating hip pain and has been for three

> years. He apparently needs a hip replacement but his HMO has been

> unwilling to schedule him for one. His wife and daughter are

> pursuing legal avenues to force the HMO to act. Two questions:

>

> 1) Any advice anyone can offer on getting an HMO (Health Net) to

act

> on this issue?

>

> 2) When the surgery is finally scheduled, are there hip appliances

> that he should either request or be wary of?

>

> Thanks in advance for any help.

>

> -- Alan

[Guest guest]

> My father-in-law is in excruciating hip pain and has been for three

> years. He apparently needs a hip replacement but his HMO has been

> unwilling to schedule him for one. His wife and daughter are

> pursuing legal avenues to force the HMO to act. Two questions:

>

> 1) Any advice anyone can offer on getting an HMO (Health Net) to

act

> on this issue?

As someone else advised, you can check the insurance policy to see

what your appeal options are. Its not clear whether the patient

can't get to see a specialist, or get the surgery itself. Is a

surgeon saying a THR is needed and they won't schedule it?

>

> 2) When the surgery is finally scheduled, are there hip appliances

> that he should either request or be wary of?

You can reveiew the pluses and minuses of devices at

http://www.activejoints.com/

Depending on how young or active your father is, perhaps the device

does not matter all that much. Choose a surgeon who does many hip

replacements. Someone who does at least 50 per year (that's at least

one a week). That is the single best indicator of surgical success.

Also be aware that not all surgeons offer all devices due to hospital

contracts with suppliers (and not every supplier has every option).

Going to a surgeon is more like going to an auto dealership than many

will admit. Given the difficulties you are reporting perhaps he

doesn't have many options, anyway, but it might be good to check

ahead of time and/or get a second opinion from a second dealership

(i.e. a surgeon in a different group or with a different hospital).

[Guest guest]

Suggestion: If your father-in-law is covered by Medicare, have him check out the prospect of shifting out of his HMO to Medicare direct, with a secondary with a private insurance carrier, such as AARP. I think Medicare is more sensitive to patient needs than many HMOs.

A. I. Gordonkbrews <kbrews@...> wrote:

> My father-in-law is in excruciating hip pain and has been for three > years. He apparently needs a hip replacement but his HMO has been > unwilling to schedule him for one. His wife and daughter are > pursuing legal avenues to force the HMO to act. Two questions:> > 1) Any advice anyone can offer on getting an HMO (Health Net) to act > on this issue?As someone else advised, you can check the insurance policy to see what your appeal options are. Its not clear whether the patient can't get to see a specialist, or get the surgery itself. Is a surgeon saying a THR is needed and they won't schedule it?> > 2) When the surgery is finally scheduled, are there hip appliances > that he should

either request or be wary of? You can reveiew the pluses and minuses of devices athttp://www.activejoints.com/Depending on how young or active your father is, perhaps the device does not matter all that much. Choose a surgeon who does many hip replacements. Someone who does at least 50 per year (that's at least one a week). That is the single best indicator of surgical success. Also be aware that not all surgeons offer all devices due to hospital contracts with suppliers (and not every supplier has every option). Going to a surgeon is more like going to an auto dealership than many will admit. Given the difficulties you are reporting perhaps he doesn't have many options, anyway, but it might be good to check ahead of time and/or get a second opinion from a second dealership (i.e. a surgeon in a different group or with a different

hospital).

[Guest guest]

Thanks to all who have replied so far. Very helpful! -- Alan

Re: Re: Hip replacement advice

>

> Suggestion: If your father-in-law is covered by Medicare, have him check

out the prospect of shifting out of his HMO to Medicare direct, with a

secondary with a private insurance carrier, such as AARP. I think Medicare

is more sensitive to patient needs than many HMOs.

>

> A. I. Gordon

>

> kbrews <kbrews@...> wrote:

>

> > My father-in-law is in excruciating hip pain and has been for three

> > years. He apparently needs a hip replacement but his HMO has been

> > unwilling to schedule him for one. His wife and daughter are

> > pursuing legal avenues to force the HMO to act. Two questions:

> >

> > 1) Any advice anyone can offer on getting an HMO (Health Net) to

> act

> > on this issue?

>

> As someone else advised, you can check the insurance policy to see

> what your appeal options are. Its not clear whether the patient

> can't get to see a specialist, or get the surgery itself. Is a

> surgeon saying a THR is needed and they won't schedule it?

>

> >

> > 2) When the surgery is finally scheduled, are there hip appliances

> > that he should either request or be wary of?

>

> You can reveiew the pluses and minuses of devices at

> http://www.activejoints.com/

>

> Depending on how young or active your father is, perhaps the device

> does not matter all that much. Choose a surgeon who does many hip

> replacements. Someone who does at least 50 per year (that's at least

> one a week). That is the single best indicator of surgical success.

> Also be aware that not all surgeons offer all devices due to hospital

> contracts with suppliers (and not every supplier has every option).

> Going to a surgeon is more like going to an auto dealership than many

> will admit. Given the difficulties you are reporting perhaps he

> doesn't have many options, anyway, but it might be good to check

> ahead of time and/or get a second opinion from a second dealership

> (i.e. a surgeon in a different group or with a different hospital).

>

>

>

>

[Guest guest]

Hello Marty, I am 37 female and have had right and left knee replacement and

right hip replacement.In all i went to dr ain for a second opinion to agree

with my orthopedist at home in Ct. My orthopedist is the chief of surgeon at the

hospital and a professor at the Yale medical school. I was really disappointed

by Dr Ain when i went for a visit. He seem to attend to beepers and phone calls

versus talking with a patient that came from outstate. I was in the nursing home

for about 8 week and all together to get my rolling and physical theraphy it

took almost 6 months till i was back to myself. I have diastrophic dwarfism so i

have lots of joint complications,I have no pain in my right and left knee

replacment and no pain in my hip replacement. I would recommed that you find a

good orthopedist in your area. I did aqua therpahy to see if it helped me. My

orthopedist really tried conserved measures. My hip had to be custom made and

all together it took 3 months for the mold of

the hip to be me.I can say that being close to home for my surgery was better

for me .I had friends and family.My knee is about 6 years on the right and the

left one will be 1 year on May 5 and my right hip is about 4 years. I have tons

of article to help one in deciding in getting a replacement if your interest. I

can chat with you at any time also. I found the ez-step portable step to be of

great assitance its for people who have had replacments. My name is and I

live in connecticut.Most insurance companies will not pay full amount foor out

of network doctor. In regard to nursing homes afther the surgery i visited

before hand and set up my space and explained to them what my limitations where

do to my height.Im 4ft5 inches. It would my pleasure to talk with you at any

time.

Sincerly,

chachi_woost@...

Martha -Merritts <medavis@...> wrote:

OK, age has caught up with me and I can't run away from having to look

into getting a hip replacement. I plan to look into having Dr. Ain do

it (if my insurance company will agree) but I need to know from those

who have had it done the following:

-has it helped?

-how long was your recovery/rehab time?

-who did yours and where?

Thanks!

-marty (the lady one)

[Guest guest]

Dr Pelker phd Md at Yale New Haven hospital in New Haven ct

Martha -Merritts <medavis@...> wrote:

-who did yours and where?

[Guest guest]

Hi Marty (the lady one),

Hmmm, either this will be posted twice, or this will be the first

because I hit the wrong button. I'm very blessed in the sense that my

insurance (NJ BC/BS) paid for 3 surgeries (in a NYC hospital) in a 12

month period. I think I paid for part of an MRI, and of course my

annual deductable.

>has it helped?<

I think it was a tremendous help. I have been (hip) painless since.

But, then what is there to hurt, when it's all foreign matter. The few

times I can feel a twitch is because I'm laying in an odd postion and

I'm stretching a muscle associated in that area.

> -how long was your recovery/rehab time?<

I went to rehab after the second one, intense for a week at a local

hospital, then I went for out patient in the next town over. I had my

second one done in September and by early-November I peaked and would

have been able to return to work. I continued out-patient trying to

loosen up my tight hamstrings SED issue, which is the reason I now use

a scooter. By January I realized the hamstring issue wasn't going away

and I finally returned to work full-time.

> -who did yours and where?<

My hip replacements were done by:

Mathias Bostrom, M.D., at the Hospital for Special Surgery in NYC. I

know he's treated several LPs. And even more have been seen at HSS by

varying physicians. They now have a dysplasia clinic, new since I've

been there.

http://www.hss.edu/

Hospital for Special Surgery

535 East 70th Street

New York, NY 10021

Mathias Bostrom, M.D. received his education and training at the

University of Virginia and s Hopkins. After completing his

residency and two fellowships at the Hospital for Special Surgery/New

York Hospital – Cornell Medical Center he started his orthopaedic

practice at the Hospital for Special Surgery in 1996. Dr. Bostrom is

also the Chief of Orthopaedics at Helen Hospital in West

Haverstraw, New York. In addition to his research interests in bone

biology and bone regeneration, his main clinical interests are hip and

knee surgery especially complex reconstructions as well as the

treatment of musculoskeletal infections.

Office Locations

535 East 70th Street, 3rd Floor

Between York Avenue

and the East River

Phone: 212 606-1674

Fax: 212 472-3713