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Re: insurance code/fraud

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> Well...coding it as a THR does smell suspiciously like insurance

> fraud.

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It might qualify as fraudulous *if* the word " THR " would be used.

However I believe that is not the case based on my experience. Here

is my story:

I was so (positively) surprised (but skeptical) when I heard from the

OS office that the request for my Resurf was approved, that I

contacted my insurance to hear it " from the horses mouth " . Reason for

my skepticism was that a friend of mine (who had, I thought, the same

insurance coverage) had been rejected and ended up going to Belgium.

Anyway I was careful not to mention " resurfacing " and extracted the

following information: the approval was for procedure 27130 which

means " arthroplasty " . So no misinformation involved here as far as I

can tell.

Now about the money issue. I gave a detailed breakdown of the cost

and payments of my bills in msg #22797. Hospital bill included the C+

prosthesis and was paid in full! The OS's fee was " discounted "

fiercely. That may be the issue why OS's want a different code.

Ed

Mont RC+ Nov 03

PS. I was just going thru the motions exploring if I were a good

Resurf candidate and finding out more about the procedure. But I was

resigned to maybe have to wait another year till Resurf was FDA

approved, or maybe even having to go to Belgium. Imagine my surprise..

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