Re: How are people paying for revision surgery?

[Guest guest]

Hi Pamela,

As said, Dr. Boachie did my revision surgery, 13 years ago, and

he did not " take " my insurance, meaning that he would not accept

assignment and I had to seek the payment from my insurance company

myself. It's like the very, very old way all medical insurance was

handled, before assignment of claims. I got the bill from Dr.

Boachie, and I had to submit it to the insurance company for payment.

(I forgot which insurance company we were with at the time.) Dr.

Boachie, unlike Dr. Keim in 1977 when I had my Harrington Rod surgery,

did not require that I lay out the money and get reimbursed by the

insurance company. He waited until they paid me and then I paid him.

They paid about half the amount due and denied the rest. I appealed,

twice, and Dr. Boachie helped with the appeal by writing detailed

letters to the insurance company. They eventually paid all but $5000

and Dr. Boachie forgave that amount. My insurance covered the

hospital bill. We did have several thousand dollars in out of pocket

expenses to meet our deductible. I don't know if Dr. Boachie handles

insurance claims the same way now.

I think you need to find out the process for getting approval for out

of network care. Everything depends on your particular insurance

company. Anyone's experiences with a different insurer can only be

educational. It may be that after you chose a physician who accepts

your insurance, that physician's staff may be used to dealing with

your insurance company and how to apply for out of network payment.

Good luck.

Bonnie

[Guest guest]

Izarah,

Most of the "problems" with health insurance in the United States has been corrected with the new Health Reform Law passed early this year. Most aspects are part of the Federal Employee Health Benefits Program that covers all United States Federal and Postal Employees. This includes NO pre-existing condition clause in any health insurance plan.

www.healthcare.gov

www.opm.gov/insure/health/index.asp

S.

Re: [ ] Re: How are people paying for revision surgery?

Received: Thursday, December 2, 2010, 4:07 PM

Reading these stories I know I am very fortunate. At the time of my revision surgery, I had BCBS of NC. My hubby was on a job in Alabama and was required to carry BCBS of MA. I took advantage of it and scheduled my revision while we had dual coverage. The only thing I remember paying was the deductible of $1,000 to Dr. Hey. I never saw any hospital bills. I may have had a small bill from the vascular surgeon that did the anterior incision but that is it. I was very fortunate!

Peggy

>

> Hi. I am still new here. I am 50 yo and live in Binghamton NY. I had a double curve and Harrington rod put in in 77'. The severe pain in my lower back and neck has led me to two Drs. The first local dr. said the rod must come out. Period. The second opinion local dr. said he needs to do a 360 entry and insert the cages in my two last lumbar discs bec all my upper body weight is pushing on that first fusion free disc. He has done maybe 3 surgeries a year (young guy). He recommended pain management injections which I am about to schedule.

>

> I mentioned the big name NYC revision drs to him and he said they do not take any insurance. Surgery run $50,000 to $250,000!

How are people paying for this? I have Fidelis, which no one but the first ("take the rod out")dr takes. I had to pay cash to the second dr for his opinion bec his office doesn't take my insurance and I wanted a second opinion anyway.

>

> So who pays for everyone's revision? Private insurance? Which one? I have never had private insurance. What are the co-pays with private insurance? Thousands?

>

> I sincerely PREY to GOD the injections take away my pain for a couple of years bec my insurance does pay for that. Does anyone have advice on how to get the most out of these injections?

>

> Thank you, Pamela Hanley

>

[Guest guest]

Prior to the new Health Care Reform law, if a Health Insurance Plan would not cover a pre-existing condition, scoliosis would be a pre-existing condition if an individual had been diagnosed with it prior to obtaining that insurance. It would be my guess that although the current issue is flatback syndrome, it was due to a prior surgery to "cure" scoliosis, so it would most likely be considered pre-existing, and therefore not covered.

Pamela, you may want to refer to the link, www.healthcare.gov, to review health insurance options under the Health Care Reform Law within New York State.

Hope this helps!!

S.

Re: [ ] Re: How are people paying for revision surgery?

Received: Thursday, December 2, 2010, 4:07 PM

Reading these stories I know I am very fortunate. At the time of my revision surgery, I had BCBS of NC. My hubby was on a job in Alabama and was required to carry BCBS of MA. I took advantage of it and scheduled my revision while we had dual coverage. The only thing I remember paying was the deductible of $1,000 to Dr. Hey. I never saw any hospital bills. I may have had a small bill from the vascular surgeon that did the anterior incision but that is it. I was very fortunate!

Peggy

>

> Hi. I am still new here. I am 50 yo and live in Binghamton NY. I had a double curve and Harrington rod put in in 77'. The severe pain in my lower back and neck has led me to two Drs. The first local dr. said the rod must come out. Period. The second opinion local dr. said he needs to do a 360 entry and insert the cages in my two last lumbar discs bec all my upper body weight is pushing on that first fusion free disc. He has done maybe 3 surgeries a year (young guy). He recommended pain management injections which I am about to schedule.

>

> I mentioned the big name NYC revision drs to him and he said they do not take any insurance. Surgery run $50,000 to $250,000! How are people paying for this? I have Fidelis,

which no one but the first ("take the rod out")dr takes. I had to pay cash to the second dr for his opinion bec his office doesn't take my insurance and I wanted a second opinion anyway.

>

> So who pays for everyone's revision? Private insurance? Which one? I have never had private insurance. What are the co-pays with private insurance? Thousands?

>

> I sincerely PREY to GOD the injections take away my pain for a couple of years bec my insurance does pay for that. Does anyone have advice on how to get the most out of these injections?

>

> Thank you, Pamela Hanley

>

[Guest guest]



After Cobra I had too many health problems to get the Blue Advantage. I started a Sole Proprietorship and a local insurance agent helped me get BCBS for my group of one. A few years ago BCBS decided to not renew my insurance because I made more on a W2 at my church than I did in my business. I got around it by turning my sole proprietorship into an S Corporation and having the church pay me on a 1099.

Peggy

Re: [ ] Re: How are people paying for revision surgery? Received: Thursday, December 2, 2010, 4:07 PM

Reading these stories I know I am very fortunate. At the time of my revision surgery, I had BCBS of NC. My hubby was on a job in Alabama and was required to carry BCBS of MA. I took advantage of it and scheduled my revision while we had dual coverage. The only thing I remember paying was the deductible of $1,000 to Dr. Hey. I never saw any hospital bills. I may have had a small bill from the vascular surgeon that did the anterior incision but that is it. I was very fortunate!

Peggy

>> Hi. I am still new here. I am 50 yo and live in Binghamton NY. I had a double curve and Harrington rod put in in 77'. The severe pain in my lower back and neck has led me to two Drs. The first local dr. said the rod must come out. Period. The second opinion local dr. said he needs to do a 360 entry and insert the cages in my two last lumbar discs bec all my upper body weight is pushing on that first fusion free disc. He has done maybe 3 surgeries a year (young guy). He recommended pain management injections which I am about to schedule. > > I mentioned the big name NYC revision drs to him and he said they do not take any insurance. Surgery run $50,000 to $250,000! How are people paying for this? I have Fidelis, which no one but the first ("take the rod out")dr takes. I had to pay cash to the second dr for his opinion bec his office doesn't take my insurance and I wanted a second opinion anyway.> > So who pays for everyone's revision? Private insurance? Which one? I have never had private insurance. What are the co-pays with private insurance? Thousands? > > I sincerely PREY to GOD the injections take away my pain for a couple of years bec my insurance does pay for that. Does anyone have advice on how to get the most out of these injections? > > Thank you, Pamela Hanley>