Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Yes you are correct. I was going to go to Dr. Gross for my resurf, but insurance issues made it necessary for me to go to Dr. DeSmet in Belgium. However, in one of my conversation with Dr. Gross, he did state that there was no code for resurfacing, so doctors were using the code for a THR. Which he stated is exactly what a resurf is. It is a THR, it is just not as invasive as the traditional THR. The acetabelum portion is identical to a THR. The femoral head is receiving a prothesis just as in the THR, but this prothesis is just not as intrusive as those used in a traditional THR. Lloyd RBHR Sept 17,2003 ala DeSmet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 surface hippy board Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Dr Gross codes his procedure as a hip replacement because there is no code for resurfacing at this point in time. After all, this IS a form of hip replacement. It just isn't as extreme as a Total Hip replacement, that's all. Nothing unethical going on at all. If there were a specific code for resurfacing, I'm sure he'd use it. There would probably be a lot more battles with insurance companies, but ... I'm very happy with the way things are going! Gross 6/12/03 RHR C2K Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 I was resurfed by Dr. Gross. After 2 failed internal reviews, I prepared for battle. As part of the preparation, I requested a copy of the letter sent to my insurance company by Dr. Gross. It states that resurfacing is not experimental but the device is investigational. It references the advantages, the device usage in Europe, the IDE clinical trial and his involvement in the trial. The insurance company must be advised of the study. Stan aka Wolf (L-C2K 01/17/02) > I am an old surfer ala Dr. Gross. I had to fight for my coverage > tooth and nail. It took me 6 months and 4 denials. Dr. Gross was > completely honest about coding. I'm not the only former patient of > Dr. G who went through this. To , I think you need to ask Dr. > Gross personally if he intentionally miscodes surgery. He may have > a " free-thinker " in the office whom he knows nothing about. If what > you say is true and I highly doubt it, this would have serious > consequences for Dr. Gross. I am so incensed by this post that I > just may contact his office myself if I don't see someone on this > board develope some ethics. > Trudy > Bilat Cormet 1/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Thanks Stan for clearing up murky waters.... The question is: " What happens when the procedure is no longer part of the study, but continued access? " There must be someway it is explained to insurance. I'm still completely certain that Dr. Gross operates ethically. I remember that at the very beginning he personnaly went before the board for Blue Cross in SC and successfully argued for approval of the procedure. Trudy > > I am an old surfer ala Dr. Gross. I had to fight for my coverage > > tooth and nail. It took me 6 months and 4 denials. Dr. Gross was > > completely honest about coding. I'm not the only former patient of > > Dr. G who went through this. To , I think you need to ask > Dr. > > Gross personally if he intentionally miscodes surgery. He may have > > a " free-thinker " in the office whom he knows nothing about. If > what > > you say is true and I highly doubt it, this would have serious > > consequences for Dr. Gross. I am so incensed by this post that I > > just may contact his office myself if I don't see someone on this > > board develope some ethics. > > Trudy > > Bilat Cormet 1/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 The silly thing about the insurance co's is that the cost differences of resurfacing vs. THR are probably no more than about $2000, which I think ANY of us would be willing to pay out of pocket just to get this option - does anyone think the insurance co's are truly ethical?? Go see the movie the Rainmaker with Danny Devito and, I think, Matt Damon - obviously the movie is an exxageration, but we had a case here at Dupont where the husband of one of our employees broke his leg, and was refused help by some hospital or whatever over some insurance question, and he had to wait several days to get his leg set!! If the insurance co's thought long-term, they might see the resurfacing as saving them money in the long term - not having to pay for replacing polyethylene joint liners every 10 yrs or so...... Ken " sjwolf " sjwolf@...> on 10/15/2003 12:00:57 PM Please respond to surfacehippy To: surfacehippy cc: Subject: Re: Dr. G and insurance I was resurfed by Dr. Gross. After 2 failed internal reviews, I prepared for battle. As part of the preparation, I requested a copy of the letter sent to my insurance company by Dr. Gross. It states that resurfacing is not experimental but the device is investigational. It references the advantages, the device usage in Europe, the IDE clinical trial and his involvement in the trial. The insurance company must be advised of the study. Stan aka Wolf (L-C2K 01/17/02) > I am an old surfer ala Dr. Gross. I had to fight for my coverage > tooth and nail. It took me 6 months and 4 denials. Dr. Gross was > completely honest about coding. I'm not the only former patient of > Dr. G who went through this. To , I think you need to ask Dr. > Gross personally if he intentionally miscodes surgery. He may have > a " free-thinker " in the office whom he knows nothing about. If what > you say is true and I highly doubt it, this would have serious > consequences for Dr. Gross. I am so incensed by this post that I > just may contact his office myself if I don't see someone on this > board develope some ethics. > Trudy > Bilat Cormet 1/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Interesting question. I would suspect that it would simply be considered a non FDA approved device and treated as such by the insurance companies. However, there may be a category for devices pending FDA approval. This would be a good question for at Corin, one of the good Doctors or one of our insurance reps. Wolf > Thanks Stan for clearing up murky waters.... The question > is: " What happens when the procedure is no longer part of the study, > but continued access? " There must be someway it is explained to > insurance. I'm still completely certain that Dr. Gross operates > ethically. I remember that at the very beginning he personnaly went > before the board for Blue Cross in SC and successfully argued for > approval of the procedure. > Trudy > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Thanks for mentioning this Lloyd - I forgot that this is what I also was told by Dr. Gross' staff - also, there is almost no need for supplementary blood during a resurface due to the fact that the femur is not opened up into the marrow, as I understand it - somebody correct me if I'm wrong, but I know I had already donated a pint for my originally-scheduled THR, then cancelled when I discovered resurf, and I was supposed to donate a second pint ahead of time also. Lee Webb, Dr. Gross' assistant, told me no blood was likely to be needed. Ken Gross rhr 9/18/03 flo1dude2@... on 10/15/2003 01:42:19 PM Please respond to surfacehippy To: surfacehippy cc: Subject: Fwd: Re: Dr. G and insurance Yes you are correct. I was going to go to Dr. Gross for my resurf, but insurance issues made it necessary for me to go to Dr. DeSmet in Belgium. However, in one of my conversation with Dr. Gross, he did state that there was no code for resurfacing, so doctors were using the code for a THR. Which he stated is exactly what a resurf is. It is a THR, it is just not as invasive as the traditional THR. The acetabelum portion is identical to a THR. The femoral head is receiving a prothesis just as in the THR, but this prothesis is just not as intrusive as those used in a traditional THR. Lloyd RBHR Sept 17,2003 ala DeSmet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 I accept that a THR code may be used. However, not all insurance companies will cover devices / procedures that are not FDA approved. That is why the Dr must advised the insurance company that the device is in clinical trials seeking FDA approval. Your problems with coverage, I suspect, result from this disclosure. Wolf > Yes you are correct. I was going to go to Dr. Gross for my resurf, but > insurance issues made it necessary for me to go to Dr. DeSmet in Belgium. > However, in one of my conversation with Dr. Gross, he did state that there was > no code for resurfacing, so doctors were using the code for a THR. Which he > stated is exactly what a resurf is. It is a THR, it is just not as invasive > as the traditional THR. The acetabelum portion is identical to a THR. The > femoral head is receiving a prothesis just as in the THR, but this prothesis is > just not as intrusive as those used in a traditional THR. > > Lloyd > RBHR Sept 17,2003 ala DeSmet > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Ken .. I agree ... the short term costs are very similar. There is less chance (IMHO) that PT will be required and long term (if all goes well), fewer (or no) revisions. Often the insurance company (or Medical Director) will not question the effectiveness of the procedure or device but they must stay within the contract wording. If I would have gone into an external review, it would not have been the device or procedure being questioned but the contract wording regarding coverage for a non FDA approved device. Sadly, if the Dr doesn't play the game, he and the hospital are in serious trouble. Wolf > > The silly thing about the insurance co's is that the cost differences of > resurfacing vs. THR are probably no more than about $2000, which I think > ANY of us would be willing to pay out of pocket just to get this option - > does anyone think the insurance co's are truly ethical?? Go see the movie > the Rainmaker with Danny Devito and, I think, Matt Damon - obviously the > movie is an exxageration, but we had a case here at Dupont where the > husband of one of our employees broke his leg, and was refused help by some > hospital or whatever over some insurance question, and he had to wait > several days to get his leg set!! If the insurance co's thought > long-term, they might see the resurfacing as saving them money in the long > term - not having to pay for replacing polyethylene joint liners every 10 > yrs or so...... > > Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2003 Report Share Posted October 15, 2003 Ken, I am concerned about the implication that Dr. G is unethical certainly not the insurance cos. Everyone knows they're thieves and liars with contract law on their side. I hate 'em. I recently took my college age daughter to the doc to check ongoing sickness. While there I was told she's been cancelled by insurance as of 10/7. We had to show that she was attending college and in good standing in order to continue her on our insurance. I'd just checked this last Friday that all was in order. Well the number I call says that but the number the docs office calls says different and they can't get their act together. As my contact asks, " why not, we're reading the same computer screen? " Somehow by doing this as a rule I believe they will save some bucks somewhere in the gap between the cancellation and reinstatement. If nothing else they will try and hope you give up fighting them to make it right. If they do this often enough the dollars add up. Scum.... Trudy > > I am an old surfer ala Dr. Gross. I had to fight for my coverage > > tooth and nail. It took me 6 months and 4 denials. Dr. Gross was > > completely honest about coding. I'm not the only former patient of > > Dr. G who went through this. To , I think you need to ask > Dr. > > Gross personally if he intentionally miscodes surgery. He may have > > a " free-thinker " in the office whom he knows nothing about. If > what > > you say is true and I highly doubt it, this would have serious > > consequences for Dr. Gross. I am so incensed by this post that I > > just may contact his office myself if I don't see someone on this > > board develope some ethics. > > Trudy > > Bilat Cormet 1/02 > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.