Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 hi bucky- congratulations on your insurancve approval. that's great news. now you can get on with the important part of the process. look forward, don't trip up. my 2 cents......how and why you got " american euros " from the insurance company is not worth " discussing " with anybody who might have the connections or authority to re-evaluate their coverage of your upcoming resurfacing operation, don't you think? why push your luck.....just get your body fixed. best wishes on your upcoming suregery, jeff left-desmet-3 months Insurance approval Well just got my approval in the mail on the first shot. Going to the JRI to have my rt hip. resurfaced by Dr. Amstutz. They approved it as a " Non Network Provider " I believe this is because the sent it in as a THR. Now my question is, does anybody think it would be worth my while to go back to the insurance company and explain to them that the reason for me going to California (I live in Ohio) is because nobody within our network does this surgery (resurfacing). Hoping, of course, they (the insurance) would change the reimbursement rate. I have been reading alot of conversations about the way JRI is sending this to insurance companies for approval. Or should I be thankful it was approved and go get it done. Thanks for the input. Bucky ------------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Dear Bucky, DO NOT contact your insurance company! I've spent the last 9 months fighting the insurance battle because the JRI was coding this as a " unlisted procedure. " Their policy change has come too late for me. I now have such severe damage that even Koen thinks I must have resurfacing done soon, with a device that has the option of a dysplasia cup with screws (which we don't have in the US). Back in June, I was still a candidate for a routine resurface job. Now, I'll be flying to Belgium, counting on Koen's skill and experience to make this happen, and paying for it out of pocket. Be thankful it was approved and go get it done! There will be plenty of time after FDA approval for surgeons to present their case to the AMA for a new code with higher reimbursement. Once a sizeable number of them are doing this procedure, they should have the clout to make this happen. In the meantime, virtually all the other US surgeons authorized to use these devices (the Conserve + and the Corin device) on the small number of patients involved in the clinical trials and the under the " continued access " policy, seem to have been getting by just fine financially these past few years! They continue to accept new resurfacing patients knowing that reimbursement will be at the THR figure. Congratulations on your speedy approval! Don't rock the boat, just get it done! Insurance approval > Well just got my approval in the mail on the first shot. Going to the > JRI to have my rt hip. resurfaced by Dr. Amstutz. They approved it as > a " Non Network Provider " I believe this is because the sent it in as > a THR. Now my question is, does anybody think it would be worth my > while to go back to the insurance company and explain to them that > the reason for me going to California (I live in Ohio) is because > nobody within our network does this surgery (resurfacing). Hoping, of > course, they (the insurance) would change the reimbursement rate. I > have been reading alot of conversations about the way JRI is sending > this to insurance companies for approval. Or should I be thankful it > was approved and go get it done. > > Thanks for the input. > > Bucky > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 I believe it would, Bucky. You have to play them at their own game to beat them at it. If/when they deny you again take the issue up again logically and reasonably for the requisite third time, then move up to your state's insurance division. If state begins a dialogue with your insurance company and if you hang in there long enough, they may decide to pay you off just to stop having to deal with you. Hopefully (I dream!) they will accept the logic and reason of your argument outright and not make you go the distance, but I doubt it. Good luck! Dr Steve Vince Bilat BHR De Smet Jan 6, 2004 > Well just got my approval in the mail on the first shot. Going to the > JRI to have my rt hip. resurfaced by Dr. Amstutz. They approved it as > a " Non Network Provider " I believe this is because the sent it in as > a THR. Now my question is, does anybody think it would be worth my > while to go back to the insurance company and explain to them that > the reason for me going to California (I live in Ohio) is because > nobody within our network does this surgery (resurfacing). Hoping, of > course, they (the insurance) would change the reimbursement rate. I > have been reading alot of conversations about the way JRI is sending > this to insurance companies for approval. Or should I be thankful it > was approved and go get it done. > > Thanks for the input. > > Bucky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 > > Well just got my approval in the mail on the first shot. Going to the > > JRI to have my rt hip. resurfaced by Dr. Amstutz. They approved it as > > a " Non Network Provider " I believe this is because the sent it in as > > a THR. Now my question is, does anybody think it would be worth my > > while to go back to the insurance company and explain to them that > > the reason for me going to California (I live in Ohio) is because > > nobody within our network does this surgery (resurfacing). Hoping, of > > course, they (the insurance) would change the reimbursement rate. I > > have been reading alot of conversations about the way JRI is sending > > this to insurance companies for approval. Or should I be thankful it > > was approved and go get it done. > > > > Thanks for the input. > > > > Bucky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 Hi , Probably totally coincidence but I had my life saving Resurface on my son's 20th birthday......... When I rang to establish the date the receptionist said 7 Aug and I said son's birthday, she said 'Is that a problem' - no way said I - what better birthday present to him than a mother who may not be grizzling endlessly about pain and misery.......... Best of luck with all the organisation.......... one I know here got one weeks notice to be in another State for his and managed....... maybe more challenge going intercountry but I am sure manageable........ Edith LBHR Dr. L Walter Syd Aust 8/02 > I've decided to try for the March 3rd date--just need to talk to the > boss about it in the AM. I'm in way too much pain to wait until April 28th, > and afraid I would have too much damage by then, anyway. 's a senior in > high school and has enough senioritis already without spending 2 weeks > oogling beautiful women in Belgium! Seriously, we've talked about it, and > he's okay with my going then, but doesn't feel he could miss 2 weeks of > school this quarter. He's got some tough classes. > Thanks for the input. > Przygoda Quote Link to comment Share on other sites More sharing options...
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