RE: Insurance denial for a THR???

[Guest guest]

--- ph,

Good to hear from you again.

Very sorry to hear this news. I myself have BC/BS in Wash.

State and it never ceases to amaze me how the forked tongue of the

insurance world is in the viral stage. Sure wish there was a shot we

could all take to prevent the spread of this bull. I didn't realize

you had problems with your resurfased hip. Was it questionable when

you were first examined before you got the resurfased hip? Sure hope

you have many great years of pain free life on the new one. I really

appreciated all your help when I was doing my investigation. I am at

8 wks and feeling so much better. I have been in therapy pool for the

last mo. Sure feels good to get in the pool but I hate the strong

chlorine they put in it. Next week I will be starting to go to the

gym instead.

Tug C+ Boyd 11/03

surfacehippy , " ph " wrote:

>

> When I had my resurfacing surgery last year, I had Highmark Blue

Cross/Blue Shield of Western Pennsylvania, and they paid my entire

bill. I even got preapproval twice from them, so they knew exactly

what the procedure involved. My employer has since changed my

insurance coverage to a Point of Service (POS) run by Highmark Blue

Cross/Blue Shield of Western PA.

>

> When problems developed with my resurfaced hip a few months ago, I

had to return to the doctor who performed the surgery--Dr. Victor

Goldberg in Cleveland, OH. Unfortunately, he is now considered

an " out-of-network " physician, and that caused all sorts of insurance

problems.

>

> Regardless, I went and had Dr. Goldberg perform additional surgery

on me in which he had to revise my hip with a large-head THR. When

the insurance company tried to deny some of the payment because I

used and out-of-network physician, I appealed. My argument was that

no in-network physician had a clue about hip resurfacing, so how

could they make a diagnosis or effect a repair, if it could be

repaired?

>

> Today I received a letter from the insurance company conceding that

they erred in saying that I should have gone to and in-network

surgeon. However, they are now claiming that they do not pay for

experimental surgery, so they intend to denying ALL payment for my

revision surgery. Can you believe that? They want to deny payment

for a traditional THR because it replaced an experimental resurfaced

hip!

>

> All they've succeeded in doing is making me mad. They don't know

who they're dealing with. I used to be an administrative law judge,

and my job was conducting appeal hearings. This could get

interesting.

>

>

> ph K. Waltenbaugh

> Conserve Plus 12/3/02

> Conserve Total 12/9/03

>

>

> _______________________________________________

> No banners. No pop-ups. No kidding.

> Introducing My Way - http://www.myway.com

[Guest guest]

ph:

Just a quick thought here. If you STALL them long enough and the C+ is

approved in late 2004....wouldn't they have to pay then? While you head

into battle with BC/BS, it might prove to be a back-up tactic you could use.

Best of luck, I think you'll be a formidable foe!

Lois

C+ 3/27/03 Dr. Mont

Insurance denial for a THR???

When I had my resurfacing surgery last year, I had Highmark Blue Cross/Blue

Shield of Western Pennsylvania, and they paid my entire bill. I even got

preapproval twice from them, so they knew exactly what the procedure

involved. My employer has since changed my insurance coverage to a Point of

Service (POS) run by Highmark Blue Cross/Blue Shield of Western PA.

When problems developed with my resurfaced hip a few months ago, I had to

return to the doctor who performed the surgery--Dr. Victor Goldberg in

Cleveland, OH. Unfortunately, he is now considered an " out-of-network "

physician, and that caused all sorts of insurance problems.

Regardless, I went and had Dr. Goldberg perform additional surgery on me in

which he had to revise my hip with a large-head THR. When the insurance

company tried to deny some of the payment because I used and out-of-network

physician, I appealed. My argument was that no in-network physician had a

clue about hip resurfacing, so how could they make a diagnosis or effect a

repair, if it could be repaired?

Today I received a letter from the insurance company conceding that they

erred in saying that I should have gone to and in-network surgeon. However,

they are now claiming that they do not pay for experimental surgery, so they

intend to denying ALL payment for my revision surgery. Can you believe

that? They want to deny payment for a traditional THR because it replaced

an experimental resurfaced hip!

All they've succeeded in doing is making me mad. They don't know who

they're dealing with. I used to be an administrative law judge, and my job

was conducting appeal hearings. This could get interesting.

ph K. Waltenbaugh

Conserve Plus 12/3/02

Conserve Total 12/9/03

_______________________________________________

No banners. No pop-ups. No kidding.

Introducing My Way - http://www.myway.com

[Guest guest]

hi joe-

i have been following your story with much care and interest.

i'm glad to hear that you are on this side of your revision surgery

and that all seems to be going well. i really appreciate you sharing

with us your circumstances and the details of it. it certainly adds to

ther collective knowledge base going on here.

but, this story of your insurance hassles now have me mad for you.

you deserve peace of mind and all of the benefits of overcoming the

limitations of a degenerative hip.....and then doing it all over again.

i certainly hope you are able to appeal your insurance company's

decision and maybe win a big fat legal lottery in the process.

best of luck ,

jeff

bionic left hip

6 weeks ago

Insurance denial for a THR???

When I had my resurfacing surgery last year, I had Highmark Blue Cross/Blue

Shield of Western Pennsylvania, and they paid my entire bill. I even got

preapproval twice from them, so they knew exactly what the procedure involved.

My employer has since changed my insurance coverage to a Point of Service (POS)

run by Highmark Blue Cross/Blue Shield of Western PA.

When problems developed with my resurfaced hip a few months ago, I had to

return to the doctor who performed the surgery--Dr. Victor Goldberg in

Cleveland, OH. Unfortunately, he is now considered an " out-of-network "

physician, and that caused all sorts of insurance problems.

Regardless, I went and had Dr. Goldberg perform additional surgery on me in

which he had to revise my hip with a large-head THR. When the insurance company

tried to deny some of the payment because I used and out-of-network physician, I

appealed. My argument was that no in-network physician had a clue about hip

resurfacing, so how could they make a diagnosis or effect a repair, if it could

be repaired?

Today I received a letter from the insurance company conceding that they erred

in saying that I should have gone to and in-network surgeon. However, they are

now claiming that they do not pay for experimental surgery, so they intend to

denying ALL payment for my revision surgery. Can you believe that? They want

to deny payment for a traditional THR because it replaced an experimental

resurfaced hip!

All they've succeeded in doing is making me mad. They don't know who they're

dealing with. I used to be an administrative law judge, and my job was

conducting appeal hearings. This could get interesting.

ph K. Waltenbaugh

Conserve Plus 12/3/02

Conserve Total 12/9/03

_______________________________________________

No banners. No pop-ups. No kidding.

Introducing My Way - http://www.myway.com