Blue Cross/Shield and Dr. De Smet

[Guest guest]

Apparently there are a lot of lucky American Surfacehippys now who

were resurfaced by the great Dr. De Smet... For those of you who have

Blue Cross/Shield would you please advise whether or not you were

able to receive insurance reimbursement from BC/BS after filing the

forms with them? And if you were successful, what percentage did they

reimburse. Also, did you have to obtain prior approval from them,

before you had the surgery?

What I understand from reading the archives is that there is a

problem with BC/BS of California. But how have other surfacehippys

fared in the other states? I'm in New York and also have United

Health Care/Empire Plan (with the government)for non-hospital

coverage.

Talking to the insurance company has got me nowhere and further

confused. I get conflicting information each time I telephoned them.

Any information about how to receive insurance reimbursement for our

resurfacing in Belgium is greatly appreciated...

Thank You,

Bob

[Guest guest]

My advice, no matter what your insurance: If you ask, the answer

will probably be no. So don't ask ahead of time - be prepared to

pay, but get well first.

Dr. DeSmet completes the universal (US universal) 1500 form - the

form does not ask about the prosthesis used and there is no code for

resurfacing in the US or Europe (which Dr. DeSmet says uses the same

codes); the most appropriate code is the one for a THR; a BHR is,

indeed, a total hip replacement, albeit less invasive of the femur

and more elegant than most prostheses.

BC paid mine at 90% (and probably had a party considering how much

lower Dr. DeSmet fee is than US surgeons) - but that is probably a

factor dictated by your specific policy.

bev

rbhr 2/19/03

desmet (bless you Mrs. DeSmet!)

> Apparently there are a lot of lucky American Surfacehippys now who

> were resurfaced by the great Dr. De Smet... For those of you who

have

> Blue Cross/Shield would you please advise whether or not you were

> able to receive insurance reimbursement from BC/BS after filing

the

> forms with them? And if you were successful, what percentage did

they

> reimburse. Also, did you have to obtain prior approval from them,

> before you had the surgery?

>

> What I understand from reading the archives is that there is a

> problem with BC/BS of California. But how have other

surfacehippys

> fared in the other states? I'm in New York and also have United

> Health Care/Empire Plan (with the government)for non-hospital

> coverage.

>

> Talking to the insurance company has got me nowhere and further

> confused. I get conflicting information each time I telephoned

them.

> Any information about how to receive insurance reimbursement for

our

> resurfacing in Belgium is greatly appreciated...

>

> Thank You,

> Bob

[Guest guest]

My advice, no matter what your insurance: If you ask, the answer

will probably be no. So don't ask ahead of time - be prepared to

pay, but get well first.

Dr. DeSmet completes the universal (US universal) 1500 form - the

form does not ask about the prosthesis used and there is no code for

resurfacing in the US or Europe (which Dr. DeSmet says uses the same

codes); the most appropriate code is the one for a THR; a BHR is,

indeed, a total hip replacement, albeit less invasive of the femur

and more elegant than most prostheses.

BC paid mine at 90% (and probably had a party considering how much

lower Dr. DeSmet fee is than US surgeons) - but that is probably a

factor dictated by your specific policy.

bev

rbhr 2/19/03

desmet (bless you Mrs. DeSmet!)

> Apparently there are a lot of lucky American Surfacehippys now who

> were resurfaced by the great Dr. De Smet... For those of you who

have

> Blue Cross/Shield would you please advise whether or not you were

> able to receive insurance reimbursement from BC/BS after filing

the

> forms with them? And if you were successful, what percentage did

they

> reimburse. Also, did you have to obtain prior approval from them,

> before you had the surgery?

>

> What I understand from reading the archives is that there is a

> problem with BC/BS of California. But how have other

surfacehippys

> fared in the other states? I'm in New York and also have United

> Health Care/Empire Plan (with the government)for non-hospital

> coverage.

>

> Talking to the insurance company has got me nowhere and further

> confused. I get conflicting information each time I telephoned

them.

> Any information about how to receive insurance reimbursement for

our

> resurfacing in Belgium is greatly appreciated...

>

> Thank You,

> Bob