Insurance pays for Resurfacing

[Guest guest]

Hi all:

Just an update.

For those new to the site. Be aware that more insurance plans are

paying for resurfacing BUT everything depends upon your particular

plan. For example:

1. In N.C., the State Employee and Teachers Plan, which is

administered by BCBS of NC does pay for M /M hip resurfacing at " In

Plan " locations.

2. In NC most BCBS plans do not pay for resurfacing.

3. Aetna Insurance, after settling a complex multi-state law suit

with multiple medical societies, now pays for resurfacing.

EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16 DIFFERENT

PLANS JUST FOR BLUE CROSS!

In NC, I was originally denied payment at every protest level

including through the State Department of Insurance.

I recently negotiated with my real insurance company, Medical Mutual

of NC. They have instructed their plan administrator, BCBS of NC to

pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

I just received my new EOB (explanation of Benefits.

My Hospital bill of $23,433.66 was reduced by $9873.44 because of

their (BCBS) negotiated discount. Duke Hospital was then paid

$11,799.20 and my personal copay is now $1761.02

The surgical fee was separate and we are not finished yet. I expect

my cost to be less that $1,000.

Do not assume that your insurance will not pay. Check out your plan

first.

in NC

[Guest guest]

--- Good knowledge, but bad advice!!!!! Do not " check out you

plan first " by contacting your insurance people. Let your surgeon do

this. His people speak the language.

This is one of the primary reasons for many people's failure to get

coverage in the past. They raised the red flag on their provider's

horizon and being good at their job, the insurance people " denied

coverage. "

Whether or not resurf is near FDA approval and gaining acceptance in

the medical community, still the rule that insurance companies don't

make money by paying claims but rather by denying them.

Capt Amaze_O (C+ Mont 12/17/01)

> Hi all:

>

> Just an update.

>

> For those new to the site. Be aware that more insurance plans are

> paying for resurfacing BUT everything depends upon your particular

> plan. For example:

>

> 1. In N.C., the State Employee and Teachers Plan, which is

> administered by BCBS of NC does pay for M /M hip resurfacing at " In

> Plan " locations.

> 2. In NC most BCBS plans do not pay for resurfacing.

> 3. Aetna Insurance, after settling a complex multi-state law suit

> with multiple medical societies, now pays for resurfacing.

>

> EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16

DIFFERENT

> PLANS JUST FOR BLUE CROSS!

>

> In NC, I was originally denied payment at every protest level

> including through the State Department of Insurance.

>

> I recently negotiated with my real insurance company, Medical

Mutual

> of NC. They have instructed their plan administrator, BCBS of NC

to

> pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

>

> I just received my new EOB (explanation of Benefits.

>

> My Hospital bill of $23,433.66 was reduced by $9873.44 because of

> their (BCBS) negotiated discount. Duke Hospital was then paid

> $11,799.20 and my personal copay is now $1761.02

>

> The surgical fee was separate and we are not finished yet. I

expect

> my cost to be less that $1,000.

>

> Do not assume that your insurance will not pay. Check out your

plan

> first.

>

> in NC

[Guest guest]

Since were exchanging stories, right when I thought that my insurance

was the greatest they tried the olde switch a roo.

Blue shield originally talked with Dr Boyds office in Oregon and got

the ok for the me to get the C+. I decided to call to verify. In fact

they said yes Boyd is on our PPO you have $1500 deductable $3000 stop

loss we will cover the rest. Sweet. I have the OP and 3mo latter the

bills roll in. All seems well till the last one $20,000. I saw no

part that Blue shield was to cover. I call Big Blue they tell me Boyd

is out of your coverage area. I say what! You told me all is cool

back in Oct. Bad quote they say. We will look into it. 1 wk latter

Big Blue says oops the recorded tape says we quoted you wrong so we

will eat it this time. For the future you've been warned: READ YOUR

CONTRACT. I say: what ever! Don't trust what you hear. If the doctor

is on the ppo but out of area they said no stop loss Big Blue will

cover 80%. Doctor not on the ppo out of area problably at best 50%

but most likely zip. I dodged a bullet. Tug

" davidrad01 " wrote:

> Hi all:

>

> Just an update.

>

> For those new to the site. Be aware that more insurance plans are

> paying for resurfacing BUT everything depends upon your particular

> plan. For example:

>

> 1. In N.C., the State Employee and Teachers Plan, which is

> administered by BCBS of NC does pay for M /M hip resurfacing at " In

> Plan " locations.

> 2. In NC most BCBS plans do not pay for resurfacing.

> 3. Aetna Insurance, after settling a complex multi-state law suit

> with multiple medical societies, now pays for resurfacing.

>

> EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16

DIFFERENT

> PLANS JUST FOR BLUE CROSS!

>

> In NC, I was originally denied payment at every protest level

> including through the State Department of Insurance.

>

> I recently negotiated with my real insurance company, Medical

Mutual

> of NC. They have instructed their plan administrator, BCBS of NC

to

> pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

>

> I just received my new EOB (explanation of Benefits.

>

> My Hospital bill of $23,433.66 was reduced by $9873.44 because of

> their (BCBS) negotiated discount. Duke Hospital was then paid

> $11,799.20 and my personal copay is now $1761.02

>

> The surgical fee was separate and we are not finished yet. I

expect

> my cost to be less that $1,000.

>

> Do not assume that your insurance will not pay. Check out your

plan

> first.

>

> in NC

[Guest guest]

--- Good knowledge, but bad advice!!!!! Do not " check out you plan

first " by contacting your insurance people.

Cap'n,

I read into his post to *read* your policy. I agree that one shouldn't call the

insurance company, but one can read their policy to see where they may have a

problem or a possibility of coverage.

BTW-the same goes with your auto and home insurance. If it *might* be under

your deductible, get an estimate first. If it is under, you might not want to

bother submitting a claim, as it will count against you, and you will get

nothing for it. Obviously this applies to damage to the vehicle or house only.

Cindy

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

_______________________________________________

[Guest guest]

Blue shield originally talked with Dr Boyds office in Oregon and got the ok for

the me to get the C+. I decided to call to verify. In fact they said yes Boyd is

on our PPO you have $1500 deductable $3000 stop loss we will cover the rest.All

seems well till the last one $20,000.

Geez Tug,

That must have been quite a shock to the system! Thankfully I have my approval

letters in writing from the insurance company. If they had told me it wasn't to

be covered, I would have slapped them with their letter ;-). As it is, I should

probably frame it.

Cindy

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

_______________________________________________

[Guest guest]

> Hi all:

>

> Just an update.

>

> For those new to the site. Be aware that more insurance plans are

> paying for resurfacing BUT everything depends upon your particular

> plan. For example:

>

> 1. In N.C., the State Employee and Teachers Plan, which is

> administered by BCBS of NC does pay for M /M hip resurfacing

at " In

> Plan " locations.

> 2. In NC most BCBS plans do not pay for resurfacing.

> 3. Aetna Insurance, after settling a complex multi-state law suit

> with multiple medical societies, now pays for resurfacing.

>

> EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16

DIFFERENT

> PLANS JUST FOR BLUE CROSS!

>

> In NC, I was originally denied payment at every protest level

> including through the State Department of Insurance.

>

> I recently negotiated with my real insurance company, Medical

Mutual

> of NC. They have instructed their plan administrator, BCBS of NC

to

> pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

>

> I just received my new EOB (explanation of Benefits.

>

> My Hospital bill of $23,433.66 was reduced by $9873.44 because of

> their (BCBS) negotiated discount. Duke Hospital was then paid

> $11,799.20 and my personal copay is now $1761.02

>

> The surgical fee was separate and we are not finished yet. I

expect

> my cost to be less that $1,000.

>

> Do not assume that your insurance will not pay. Check out your

plan

> first.

>

> in NC

Way to go . We can only pray that the shenanakins

stop with our insurance coverers. We keep on hoping for

an approval from the FDA. In the mean time if you have an

OS who has been doing alot of these operations and an

office administrator who has been filing for coverage, then

it is bettter to let the doctor's office handle it.

Jeff (Aetna - Full Coverage 1-3-03 / Dr. Kennedy)

[Guest guest]

> Hi all:

>

> Just an update.

>

> For those new to the site. Be aware that more insurance plans are

> paying for resurfacing BUT everything depends upon your particular

> plan. For example:

>

> 1. In N.C., the State Employee and Teachers Plan, which is

> administered by BCBS of NC does pay for M /M hip resurfacing

at " In

> Plan " locations.

> 2. In NC most BCBS plans do not pay for resurfacing.

> 3. Aetna Insurance, after settling a complex multi-state law suit

> with multiple medical societies, now pays for resurfacing.

>

> EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16

DIFFERENT

> PLANS JUST FOR BLUE CROSS!

>

> In NC, I was originally denied payment at every protest level

> including through the State Department of Insurance.

>

> I recently negotiated with my real insurance company, Medical

Mutual

> of NC. They have instructed their plan administrator, BCBS of NC

to

> pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

>

> I just received my new EOB (explanation of Benefits.

>

> My Hospital bill of $23,433.66 was reduced by $9873.44 because of

> their (BCBS) negotiated discount. Duke Hospital was then paid

> $11,799.20 and my personal copay is now $1761.02

>

> The surgical fee was separate and we are not finished yet. I

expect

> my cost to be less that $1,000.

>

> Do not assume that your insurance will not pay. Check out your

plan

> first.

>

> in NC

Way to go . We can only pray that the shenanakins

stop with our insurance coverers. We keep on hoping for

an approval from the FDA. In the mean time if you have an

OS who has been doing alot of these operations and an

office administrator who has been filing for coverage, then

it is bettter to let the doctor's office handle it.

Jeff (Aetna - Full Coverage 1-3-03 / Dr. Kennedy)

[Guest guest]

> Hi all:

>

> Just an update.

>

> For those new to the site. Be aware that more insurance plans are

> paying for resurfacing BUT everything depends upon your particular

> plan. For example:

>

> 1. In N.C., the State Employee and Teachers Plan, which is

> administered by BCBS of NC does pay for M /M hip resurfacing

at " In

> Plan " locations.

> 2. In NC most BCBS plans do not pay for resurfacing.

> 3. Aetna Insurance, after settling a complex multi-state law suit

> with multiple medical societies, now pays for resurfacing.

>

> EVERY PLAN IS DIFFERENT. IN NC ALONE THER ARE AT LEAST 16

DIFFERENT

> PLANS JUST FOR BLUE CROSS!

>

> In NC, I was originally denied payment at every protest level

> including through the State Department of Insurance.

>

> I recently negotiated with my real insurance company, Medical

Mutual

> of NC. They have instructed their plan administrator, BCBS of NC

to

> pay for my surgery perfgmed 3/31/03 at Duke Hospital, Durham, NC.

>

> I just received my new EOB (explanation of Benefits.

>

> My Hospital bill of $23,433.66 was reduced by $9873.44 because of

> their (BCBS) negotiated discount. Duke Hospital was then paid

> $11,799.20 and my personal copay is now $1761.02

>

> The surgical fee was separate and we are not finished yet. I

expect

> my cost to be less that $1,000.

>

> Do not assume that your insurance will not pay. Check out your

plan

> first.

>

> in NC

Way to go . We can only pray that the shenanakins

stop with our insurance coverers. We keep on hoping for

an approval from the FDA. In the mean time if you have an

OS who has been doing alot of these operations and an

office administrator who has been filing for coverage, then

it is bettter to let the doctor's office handle it.

Jeff (Aetna - Full Coverage 1-3-03 / Dr. Kennedy)