your insurer?

[Guest guest]

,

I'm sorry I spaced out on this...

Was/is your provider Blue Cross/Blue Shield? Did they already approve or

are you appealing?

Thanks,

Cate

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[Guest guest]

>

>Was/is your provider Blue Cross/Blue Shield? Did they already approve or

>are you appealing?

>

Cate,

My provider is not Blue Cross/Blue Shield. My resurfacing was denied, then

approved before it got to the appeal stage. I personally don't like the

idea of naming which companies are covering the procedure in an appeal, nor

do I like the threats that I hear occasionally of suing a company for not

covering procedures that their contract says they don't have to cover. We

are a liability to an insurance company (being that we have major claims

upcoming), so to tell them another company is covering it brings up the

thought in their mind " so go there then, and let THEM pay for it " .

I believe that until it is an approved device, we have to convince the

company on the merits of each of our individual cases. I tried to convince

the company that the cost of the resurfacing would be much less over the

course of my lifetime vs. THR with the accompanying revisions, etc.

Especially as in the case of my friend who has had so many problems with

her THR. I think in the letter, I mentioned that she had dislocated five

or six times. She is now up to NINE!! Add up the cost of the original

THR, ER and surgery costs to reduce the dislocations, revision, three more

dislocations, new locking ring so it doesn't come out again (she's in the

hospital as we speak), loss of work, etc, and they haven't even tackled the

second hip yet.

Your letter was outstanding!! Keep us posted on the results.

[Guest guest]

,

Thank you very much for the feedback - it's in line with the thoughts of

several others who have responded, and I very much appreciate the time

everyone has taken to help me get oriented to all this.

I'm pretty much going to stick to focusing on facts, cost benefits & as

expert testimonials as I can secure. I should know in the next 30 days or

so & will post the news as it happens.

Again, my thanks!

CateOn Sat, 23 Jun 2001 09:32:10 -0700, surfacehippy wrote:

> >

> >Was/is your provider Blue Cross/Blue Shield? Did they already approve

or

> >are you appealing?

> >

> Cate,

>

> My provider is not Blue Cross/Blue Shield. My resurfacing was denied,

then

> approved before it got to the appeal stage. I personally don't like the

> idea of naming which companies are covering the procedure in an appeal,

nor

> do I like the threats that I hear occasionally of suing a company for not

> covering procedures that their contract says they don't have to cover. We

> are a liability to an insurance company (being that we have major claims

> upcoming), so to tell them another company is covering it brings up the

> thought in their mind " so go there then, and let THEM pay for it " .

>

> I believe that until it is an approved device, we have to convince the

> company on the merits of each of our individual cases. I tried to

convince

> the company that the cost of the resurfacing would be much less over the

> course of my lifetime vs. THR with the accompanying revisions, etc.

> Especially as in the case of my friend who has had so many problems with

> her THR. I think in the letter, I mentioned that she had dislocated five

> or six times. She is now up to NINE!! Add up the cost of the original

> THR, ER and surgery costs to reduce the dislocations, revision, three

more

> dislocations, new locking ring so it doesn't come out again (she's in the

> hospital as we speak), loss of work, etc, and they haven't even tackled

the

> second hip yet.

>

> Your letter was outstanding!! Keep us posted on the results.

>

>

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