Re: JRI, Dr. Amstutz, Running, Insurance, etc.

[Guest guest]

Bucky,

This seems like a good compromise to me. A lot of insurances won't cover a

penny of the surgery or the device. $6,000. is cheap compared to what many

of us have had to pay. It hasn't passed the FDA trials yet so they have the

legal right to not pay for any of the entire procedure. If you like the

doctor and the facility, I would go for it! Believe me, you are getting off

cheap! (unless you consider the thousands of dollars of insurance premiums

that you have paid over the years...)

June RBHR De Smet 8/27/03

> Aleks,

>

> I'll respond only to the insurance part of the question. I'm scheduled to go

> to JRI next Thur. (April 1) for a Rt.Hip resurface. JRI submitted my info

> under a THR code which the insurance company approved with no problem. Then

> about two weeks ago Chuck called and said because of risk considerations

> they were going back to my insurance company and inform them they were

> specifically using an investigational device. JRI's feeling is by not

> disclosing this fact specifically they are setting themselves up for a

> possible insurance fraud problem. Well they went back and sure enough my

> insurance company said they WILL NOT cover the investigational device, BUT

> will still pay for the THR surgery. To which I was sent an e-mail stating I

> need to furnish $6050.00 prior to my surgery to cover for the device. Well I

> don't know about you guys and gals but to me that's alot of money. Chuck is a

> real nice guy and very easy to work with I'm hoping to be able to resolve this

> matter. If anybody out

> there has any other options meaning physicians that handle this differently

> I'd sure appreciate hearing from them and fast. So in a nutshell it appears

> they will cover the surgery and not the device.

>

> I guess I will comment on some other things. Dr. Amstutz came highly

> recommended by my local OS Dr. Salpietro. And the people at JRI have been

> extremely helpful.

>

> Take care

>

[Guest guest]

> Aleks,

>

> I'll respond only to the insurance part of the question. I'm

scheduled to go to JRI next Thur. (April 1) for a Rt.Hip resurface.

JRI submitted my info under a THR code which the insurance company

approved with no problem. Then about two weeks ago Chuck called

and said because of risk considerations they were going back to my

insurance company and inform them they were specifically using an

investigational device. JRI's feeling is by not disclosing this fact

specifically they are setting themselves up for a possible insurance

fraud problem.

What Chuck told me is that Orthopaedic Hospital (specifically OH's

legal counsel) insisted that JRI do this because they were concerned

that the hospital might be held liable if they didn't.

So far, Cigna hasn't changed their mind on my surgery (4/20 bilateral).

I am, however, dreading looking at my mail.

Steve (bilateral wannabe)

[Guest guest]

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Aleks,

Ditto the following for me. You indicate that Amstutz has turned you down for a

resurfacing on your right hip-- You may wish to at least send your x-rays to Dr

De Smet. He has resurfaced hips that others have refused. It IS the rest of

your life and you sound like an extremely active person- like myself. I (as

well as others) believe resurfacing to be the preferred procedure- if possible-

to returning to an active life.

Good luck,

Rock climbin' Jude

LBHR De Smet 09/11/02

Re: JRI, Dr. Amstutz, Running, Insurance, etc.

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Aleks,

Ditto the following for me. You indicate that Amstutz has turned you down for a

resurfacing on your right hip-- You may wish to at least send your x-rays to Dr

De Smet. He has resurfaced hips that others have refused. It IS the rest of

your life and you sound like an extremely active person- like myself. I (as

well as others) believe resurfacing to be the preferred procedure- if possible-

to returning to an active life.

Good luck,

Rock climbin' Jude

LBHR De Smet 09/11/02

Re: JRI, Dr. Amstutz, Running, Insurance, etc.

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Aleks,

Ditto the following for me. You indicate that Amstutz has turned you down for a

resurfacing on your right hip-- You may wish to at least send your x-rays to Dr

De Smet. He has resurfaced hips that others have refused. It IS the rest of

your life and you sound like an extremely active person- like myself. I (as

well as others) believe resurfacing to be the preferred procedure- if possible-

to returning to an active life.

Good luck,

Rock climbin' Jude

LBHR De Smet 09/11/02

Re: JRI, Dr. Amstutz, Running, Insurance, etc.

Hi Aleks,

Please allow me to take a crack at your 1st question about Dr. De

Smet: " Why does Dr. De Smet get so much attention with this group? "

From my perspective, there are several reasons:

1) Insurance Problems in the U.S.: Many U.S. insurance companies

won't authorize resurfacing surgery (unless, of course, the

requesting surgeon uses the AMA code for a THR on the request for

certification). This means prospective patients face a $25K-$40K

bill if they choose to have the surgery done in the U.S. But, when

they learn that the cost to have a BHR done by Dr. De Smet is

approximately $13K, most rejoice at the thought.

2) Long Waiting Lists in Some Countries: In some countries, there

are long waiting lists for resurfacing surgery—-and having to wait

for the procedure often jeopardizes a prospective patient's

candidacy. As a result, many folks look for an alternative: A

reasonably priced and readily available surgeon-—preferably, one with

lots of experience.

3) Experience and Skill: I dare say that many in this group—-myself

included—-believe Dr. De Smet is one of the two or three best

resurfacing surgeons in the world. We certainly cannot prove this

claim, but he is clearly one of the most experienced. More

specifically, he currently performs 10-15 BHRs a week and has done

more than 1,200 since he learned the procedure from Dr. McMinn five

years ago. Incidentally, he used to perform many different types of

orthopaedic surgery, but he now does BHRs exclusively.

4) Quick & Personal Responses: Dr. De Smet responds personally and

very quickly (usually overnight) to e-mail requests for consultation

and other information.

5) He Runs a Well-oiled Machine: Dr. De Smet conducts the " BHR

experience " in Ghent with clockwork-like precision. Everyone knows

their job and does it very professionally-—including the Jan Palfijn

Hospital staff and Dr. De Smet's team (i.e., his wife, Hugo, Jan,

Marc, etc.).

6) He's a Very Warm and Caring Person: Upon meeting Dr. De Smet, his

patients quickly learn how reassuring, warm, and caring the man is.

For example, he stopped in to see how I was doing every single day I

was in the hospital and at the Holiday Inn Gent-—a total of seven

days in a row!

Finally, I should add that Dr. De Smet resurfaced my left hip four

months ago today and I am doing very well--I'm even able to play

racquetball again after having to give it up a year ago.

Jim V.S.

LHBR, De Smet, 11/25/03

> Hi All.

> I posted some time ago. I have learned a great deal since thanks

in

> large part to you. I was the guy who was a long time member of the

> US Ski Team, National and NCAA Champion and ran 15 marathons

> including a PR in the Boston marathon of 2:32:00 as a recreational

> runner. I share this not to talk about myself, but to connect with

> those who may go through the same issues I have the past couple of

> years and want to remain active. I am now 40 years old with

> bilateral OA. I am being seen by Dr. Amstutz and I had my initial

> consult and review of my xrays. I was on an airplane and it was

> difficult for me to hear the entire conversation. I am hoping some

> of you may answer some questions or help fill in the blanks.

>

> 1. Insurance - all a big mystery! JRI got back to me and stated

> they received approval for a THR, however, disclosed that I may

have

> a resurfacing. It appears that BCBS of MA will review it when it

is

> submitted. Does this mean that they will cover the procedure and

> not the device? I am certain Chuck will clarify for me. By

> the way, this guy and JRI are a real class act! Great people.

>

> 2. Bilateral - my right hip is terrible, however, Dr. Amstutz

stated

> that I may be able to buy some time on the left hip. He talked

> about an alternative to resurfacing that sounded even less invasive

> than resurfacing, but my right hip was too far gone to be

considered

> for such a procedure. Any idea what he is referring to?

>

> 3. Running - I hear many of my new found friends getting back to

> running. I ran six miles today and just live in the normal day-to-

> day pain. I took from Dr. Amstutz that he discourages running

after

> resurfacing, where the Euro Drs seem to encourage it. Thoughts?

>

> 4. Dr. Amstutz v. De Smet - why does Dr. De Smet get so much

> attention with this group? Are there differences in the procedure,

> devices, philosophy, results?

>

> 5. Bilateral - any feedback related to those who had simultaneous

> bilateral versus waiting? Anyone have the second hip done a year

> later and wish they had them done at the same time?

>

> I really hope to become less restricted soon. I am doing this in

> large part to remain active for my children. I have two boys who

> love all sports. I just spent a week in Aspen and watching my four

> year old ski the entire Ajax mountain top to bottom and it brought

> me unbelievable joy and something I don't want to miss in the

> future. I would be ok if they didn't like those awful bumps so

> much...ouch...

>

> As always, thanks for your support. Any advice or guidance is

> greatly appreciated.

>

> Best to all....Aleks

[Guest guest]

Hi,

Just a thought.......... If insurance coys pay for a hemi surface could you

try the argument that you are only liable to pay for the cup bit???

i..e don't they use the same device in a hemi surface?

Edith LBHR Dr. L Walter Syd Australia 8/02

>

> This seems like a good compromise to me. A lot of insurances won't cover

a

> penny of the surgery or the device. $6,000. is cheap compared to what

many

> of us have had to pay. It hasn't passed the FDA trials yet so they have

the

> legal right to not pay for any of the entire procedure. If you like the

> doctor and the facility, I would go for it! Believe me, you are getting

off

> cheap! (unless you consider the thousands of dollars of insurance premiums

> that you have paid over the years...)

>

> June RBHR De Smet 8/27/03

>

> > Aleks,

> >

> > I'll respond only to the insurance part of the question. I'm scheduled

to go

> > to JRI next Thur. (April 1) for a Rt.Hip resurface. JRI submitted my

info

> > under a THR code which the insurance company approved with no problem.

Then

> > about two weeks ago Chuck called and said because of risk

considerations

> > they were going back to my insurance company and inform them they were

> > specifically using an investigational device. JRI's feeling is by not

> > disclosing this fact specifically they are setting themselves up for a

> > possible insurance fraud problem. Well they went back and sure enough my

> > insurance company said they WILL NOT cover the investigational device,

BUT

> > will still pay for the THR surgery. To which I was sent an e-mail

stating I

> > need to furnish $6050.00 prior to my surgery to cover for the device.

Well I

> > don't know about you guys and gals but to me that's alot of money. Chuck

is a

> > real nice guy and very easy to work with I'm hoping to be able to

resolve this

> > matter. If anybody out

> > there has any other options meaning physicians that handle this

differently

> > I'd sure appreciate hearing from them and fast. So in a nutshell it

appears

> > they will cover the surgery and not the device.

> >

> > I guess I will comment on some other things. Dr. Amstutz came highly

> > recommended by my local OS Dr. Salpietro. And the people at JRI have

been

> > extremely helpful.

> >

> > Take care

> >

>

[Guest guest]

Hi,

Just a thought.......... If insurance coys pay for a hemi surface could you

try the argument that you are only liable to pay for the cup bit???

i..e don't they use the same device in a hemi surface?

Edith LBHR Dr. L Walter Syd Australia 8/02

>

> This seems like a good compromise to me. A lot of insurances won't cover

a

> penny of the surgery or the device. $6,000. is cheap compared to what

many

> of us have had to pay. It hasn't passed the FDA trials yet so they have

the

> legal right to not pay for any of the entire procedure. If you like the

> doctor and the facility, I would go for it! Believe me, you are getting

off

> cheap! (unless you consider the thousands of dollars of insurance premiums

> that you have paid over the years...)

>

> June RBHR De Smet 8/27/03

>

> > Aleks,

> >

> > I'll respond only to the insurance part of the question. I'm scheduled

to go

> > to JRI next Thur. (April 1) for a Rt.Hip resurface. JRI submitted my

info

> > under a THR code which the insurance company approved with no problem.

Then

> > about two weeks ago Chuck called and said because of risk

considerations

> > they were going back to my insurance company and inform them they were

> > specifically using an investigational device. JRI's feeling is by not

> > disclosing this fact specifically they are setting themselves up for a

> > possible insurance fraud problem. Well they went back and sure enough my

> > insurance company said they WILL NOT cover the investigational device,

BUT

> > will still pay for the THR surgery. To which I was sent an e-mail

stating I

> > need to furnish $6050.00 prior to my surgery to cover for the device.

Well I

> > don't know about you guys and gals but to me that's alot of money. Chuck

is a

> > real nice guy and very easy to work with I'm hoping to be able to

resolve this

> > matter. If anybody out

> > there has any other options meaning physicians that handle this

differently

> > I'd sure appreciate hearing from them and fast. So in a nutshell it

appears

> > they will cover the surgery and not the device.

> >

> > I guess I will comment on some other things. Dr. Amstutz came highly

> > recommended by my local OS Dr. Salpietro. And the people at JRI have

been

> > extremely helpful.

> >

> > Take care

> >

>

[Guest guest]

Hi,

Just a thought.......... If insurance coys pay for a hemi surface could you

try the argument that you are only liable to pay for the cup bit???

i..e don't they use the same device in a hemi surface?

Edith LBHR Dr. L Walter Syd Australia 8/02

>

> This seems like a good compromise to me. A lot of insurances won't cover

a

> penny of the surgery or the device. $6,000. is cheap compared to what

many

> of us have had to pay. It hasn't passed the FDA trials yet so they have

the

> legal right to not pay for any of the entire procedure. If you like the

> doctor and the facility, I would go for it! Believe me, you are getting

off

> cheap! (unless you consider the thousands of dollars of insurance premiums

> that you have paid over the years...)

>

> June RBHR De Smet 8/27/03

>

> > Aleks,

> >

> > I'll respond only to the insurance part of the question. I'm scheduled

to go

> > to JRI next Thur. (April 1) for a Rt.Hip resurface. JRI submitted my

info

> > under a THR code which the insurance company approved with no problem.

Then

> > about two weeks ago Chuck called and said because of risk

considerations

> > they were going back to my insurance company and inform them they were

> > specifically using an investigational device. JRI's feeling is by not

> > disclosing this fact specifically they are setting themselves up for a

> > possible insurance fraud problem. Well they went back and sure enough my

> > insurance company said they WILL NOT cover the investigational device,

BUT

> > will still pay for the THR surgery. To which I was sent an e-mail

stating I

> > need to furnish $6050.00 prior to my surgery to cover for the device.

Well I

> > don't know about you guys and gals but to me that's alot of money. Chuck

is a

> > real nice guy and very easy to work with I'm hoping to be able to

resolve this

> > matter. If anybody out

> > there has any other options meaning physicians that handle this

differently

> > I'd sure appreciate hearing from them and fast. So in a nutshell it

appears

> > they will cover the surgery and not the device.

> >

> > I guess I will comment on some other things. Dr. Amstutz came highly

> > recommended by my local OS Dr. Salpietro. And the people at JRI have

been

> > extremely helpful.

> >

> > Take care

> >

>

[Guest guest]

Go for it, Aleks.

If I can help somehow, let me know.

Des

In a message dated 3/26/2004 4:35:50 PM Pacific Standard Time,

aleksblaise@... writes:

They can either try to

wrestle the device from me, or deal with my attorney/wife. If I

were them I suggest the former. If anyone is game I will take our

case to Washington with Des, Dave and some others and make some

noise.

[Guest guest]

Go for it, Aleks.

If I can help somehow, let me know.

Des

In a message dated 3/26/2004 4:35:50 PM Pacific Standard Time,

aleksblaise@... writes:

They can either try to

wrestle the device from me, or deal with my attorney/wife. If I

were them I suggest the former. If anyone is game I will take our

case to Washington with Des, Dave and some others and make some

noise.

[Guest guest]

Go for it, Aleks.

If I can help somehow, let me know.

Des

In a message dated 3/26/2004 4:35:50 PM Pacific Standard Time,

aleksblaise@... writes:

They can either try to

wrestle the device from me, or deal with my attorney/wife. If I

were them I suggest the former. If anyone is game I will take our

case to Washington with Des, Dave and some others and make some

noise.

[Guest guest]

Steve,

I am in a similar situation. I respond because many of us are

running into similar insurance issues. This insurance issue is a

big mystery. JRI received approval for my " THR. " Then went back

and offered that they may elect to use an investigative device

during the procedure. BCBS told JRI that they don't approve

anything until a claim is submitted. I called BCBS MA personally

and stated that I wanted to understand my potential liability. BCBS

told me I was approved. I then stated that I wanted

preauthorization for the investigative device. She again stated

that I was approved and just go get the operation. Today in the

mail I received a letter from BCBS MA that I was approved by an M.D.

in the Physician Review Unit. Good enough for me, but I may let the

mail go unread for awhile. I am scheduled for surgery on May 4th.

I will work out the details after the fact. They can either try to

wrestle the device from me, or deal with my attorney/wife. If I

were them I suggest the former. If anyone is game I will take our

case to Washington with Des, Dave and some others and make some

noise. By the way, it was Chondro-osteoplasty that was being

considered in the event I only get the right one done this time.

The left is bad and they thought they could buy some more time and

ROM.

Thanks again to all for kind your responses, support and advice.

Best of luck.

Aleks

> > Aleks,

> >

> > I'll respond only to the insurance part of the question. I'm

> scheduled to go to JRI next Thur. (April 1) for a Rt.Hip resurface.

> JRI submitted my info under a THR code which the insurance company

> approved with no problem. Then about two weeks ago Chuck

called

> and said because of risk considerations they were going back to my

> insurance company and inform them they were specifically using an

> investigational device. JRI's feeling is by not disclosing this

fact

> specifically they are setting themselves up for a possible

insurance

> fraud problem.

>

> What Chuck told me is that Orthopaedic Hospital (specifically OH's

> legal counsel) insisted that JRI do this because they were

concerned

> that the hospital might be held liable if they didn't.

>

> So far, Cigna hasn't changed their mind on my surgery (4/20

bilateral).

> I am, however, dreading looking at my mail.

>

> Steve (bilateral wannabe)