Resurfacing and the right codes

[Guest guest]

Dear Chuck,

I'm sure you noted on reading my post that I have nothing

whatsoever negative to say about JRI or their procedures, and I'm

just asking about the procedures indicated from previous posts in an

attempt to find a way to recover my health. AFTER PAYING HUGE AND

GROWING PREMIUMS FOR 18 YEARS WITH NO MAJOR CLAIMS, I JUST WANT BLUE

CROSS TO DO THE HONORABLE THING! If I'd just dropped my insurance

altogether in 2001, I'd have already saved enough to pay for most of

the surgery costs in Belguim! Instead, for seven years I've been in

pain 24hrs a day, can barely walk short distances, and can't afford

to pay for this surgery on my own any longer. And one final note -

it was a GP's injection of corticosteroids (for poison oak!) that

destroyed my left hip in the first place. I don't know how angry you

are, but it's nothing compared to what I'm feeling.

you said...

>Unfortunately, Blue Cross of CA is the single

> largest insurer in our state and it does not cover resurfacing even

> though it did routinely prior to the Fall of 2001. By the way, many

> BC/BS plans based in other states have authorized the surgery and

in

> this situation BC of CA make the payments to the hospital (and BS

of

> CA makes the payments to physicians) even though BC of CA doesn't

> authorize the surgery for its own members.

The relevant question then becomes - Can a CA resident like myself

get surface replacement surgery in another state who's BC/BS is

reimbursing for SR and then get it covered when BC/BS of CA has to

payback BC/BS of the other state? Is this a loophole in BC/BS of

CA's cost-saving strategy?

Rick