Re: The Battle is Joined...

[Guest guest]

dear sagliettigirl,

thanks for all the posts from ghent.

so you're using your laptop....does the hotel

have email/internet/computer access? i'm thinking

of bringing my laptop to while away the hours

but also thinking it's a bit of a bulky thing

to be hauling around and that being 'unplugged'

for a while might not be so bad.....

what types of exercises are you doing?

are you using the pool? steam room ? etc.

i'm on for april 2 with dr. de smet, and

wanting to make the most of all this.

cheers,

steph

april 2 rbhr de smet

[Guest guest]

: I agree with you completely. The relative lifetime cost of

the procedure compared to THR, including data from scientific papers

and websites should be included.

It also is important to cover multiple avenues of rejection by the

insurance company including conflicting statements in the policy

regarding coverage for " investigational procedures " , devices,

prothetics, clinical trials and otherreferences.

The details of each individuals case, degree of impairment, pain

levels, interference with life activities should be detailed and

supported with letters from physicians.

The details of the reasons for rejection as stipulated in the letter

from the insurance company need to be analysed and refuted point by

point.

in NC

>

> >You need to analyse your contract provisions. What does it say

> >about medical necessity, provision of prosthetic devices and

> >participation in clinical trials.

>

> Analyzing the wording in your contract and proving the contract

will cover

> your device is certainly one avenue. In my case, the contract

was worded

> that any investigational procedure or device would not be

covered. I went

> with convincing the insurance company that they would most likely

pay out

> much more for THR and subsequent care than they would to pay for

> resurfacing. I used a friend of mine as a worst-case scenario,

and the

> results thus far have borne out. My insurance co. paid for both

> resurfacings, less my co-pays. I was back to work two and 3 1/2

weeks post

> op. Hers has paid for two THR's, a revision, a locking ring on

one side, a

> brace, multiple dislocations (12 thus far!), with both open and

closed

> reductions, and she is not done yet. She can no longer work, is

on

> disability, and is constantly worried about dislocating, so all

activities

> are severely limited. Anyone want to guess who has cost the

insurance

> company more so far??

>

>

> C+ 5/25/01 and 6/28/01