Re: Hi - Yet another new guy from the Boston Area

[Guest guest]

Ken,

Welcome... you'll find many people here who know much more about all

this than I. My area of expertise is...CIGNA insurance. If it shows

up on your list of open enrollment possibilities:::RUN DON'T

WALK...AS FAR AWAY AS FAST YOU CAN FROM CIGNA.

All the best,

Alan

> Hi,

>

> > My question is, has anyone had any success getting an HMO to pay

for

> this. I know certain local bc/bs have refused...CA and MD as 2

> examples. I have gotten varying reports. I need to know this

because

> I have an open enrollment in Sept and need to know what I should

get.

> I have the choice of various HMOs and PPOs. Any opinions on which

> might have the higher odds? I know there are members out there that

> have had bc/bs of MA that have been covered but they were not

> specific to whether it was the HMO or PPO and what their co-pays

> were.

>

> Also, is there a list on here somewhere of all insurance cos that

> have paid and have refused? I think that might be beneficial to new

> guys like me.

>

> Thank you all again,

>

> Ken

[Guest guest]

Hi Boston guy! Good Luck with the insurance issue. My surgery was

scheduled for mid August and preop just refused me today. I have

BC/BS. PPO/EPO Needless to say, I am upset. My left hip is very

bad at this point. I am cane and couch bound too. Don't forget

when you have a pre-existing condition...they may not cover you.

Best wishes. Grace

> Hi,

>

> I am another in the growing list of new people to the group. I

want

> to thank all the existing members for the wealth of information

they

> have shared.

>

> Where I stand. I am a 46 years old - male. I was diagnosed with os

in

> both hips a few years back. Left side is way ahead of my right in

> degeneration. Used to be very active, jogging, tennis, softball,

> basketball...etc. It has, of course, progressed over the years to

the

> point where I need to walk with the assistance of a cane and now

> spend most of my time in a chair or on a couch. So, I have started

my

> journey down this road.

>

> I live outside of Boston and have contacted Drs. Amstutz, Gross

and

> Mont. Just like everyone else it seems, I am trying to get a

handle

> on the insurance aspect. Right now I have bc/bs HMO Blue New

England.

> My question is, has anyone had any success getting an HMO to pay

for

> this. I know certain local bc/bs have refused...CA and MD as 2

> examples. I have gotten varying reports. I need to know this

because

> I have an open enrollment in Sept and need to know what I should

get.

> I have the choice of various HMOs and PPOs. Any opinions on which

> might have the higher odds? I know there are members out there

that

> have had bc/bs of MA that have been covered but they were not

> specific to whether it was the HMO or PPO and what their co-pays

> were.

>

> Also, is there a list on here somewhere of all insurance cos that

> have paid and have refused? I think that might be beneficial to

new

> guys like me.

>

> Thank you all again,

>

> Ken

[Guest guest]

Hi Ken and welcome to the group. It is time for you to get off the

couch and get on with life. I am 40 years old with bilateral OA.

After a lifetime of high level athletics, I went from running 2:30

marathons two years ago to a crippled mess in a short period of

time. Thanks to Dr. Amstutz I am living life large again. Surgery

was a walk in the park and I resumed working ten days post op. I

workout every day, ride bicycles long distances, and I ran five

miles last week at a good pace with no problem and no pain only ten

weeks after surgery. I had my right hip done in May and I will wait

a year or longer for the left hip. I did see your email to me

directly and I will also respond to give you more details. I have

BCBS MA PPO. I speak with many people from the Boston area as well

as many others from all over the world. I am happy to assist you in

any way. It is the least I can do to repay the kind people here who

have been so supportive to me along the way. I will respond so we

can make direct contact.

Best... C+ Dr. Amstutz 5/04/04

> Hi,

>

> I am another in the growing list of new people to the group. I

want

> to thank all the existing members for the wealth of information

they

> have shared.

>

> Where I stand. I am a 46 years old - male. I was diagnosed with os

in

> both hips a few years back. Left side is way ahead of my right in

> degeneration. Used to be very active, jogging, tennis, softball,

> basketball...etc. It has, of course, progressed over the years to

the

> point where I need to walk with the assistance of a cane and now

> spend most of my time in a chair or on a couch. So, I have started

my

> journey down this road.

>

> I live outside of Boston and have contacted Drs. Amstutz, Gross

and

> Mont. Just like everyone else it seems, I am trying to get a

handle

> on the insurance aspect. Right now I have bc/bs HMO Blue New

England.

> My question is, has anyone had any success getting an HMO to pay

for

> this. I know certain local bc/bs have refused...CA and MD as 2

> examples. I have gotten varying reports. I need to know this

because

> I have an open enrollment in Sept and need to know what I should

get.

> I have the choice of various HMOs and PPOs. Any opinions on which

> might have the higher odds? I know there are members out there

that

> have had bc/bs of MA that have been covered but they were not

> specific to whether it was the HMO or PPO and what their co-pays

> were.

>

> Also, is there a list on here somewhere of all insurance cos that

> have paid and have refused? I think that might be beneficial to

new

> guys like me.

>

> Thank you all again,

>

> Ken

[Guest guest]

Hi Ken and welcome to the group. It is time for you to get off the

couch and get on with life. I am 40 years old with bilateral OA.

After a lifetime of high level athletics, I went from running 2:30

marathons two years ago to a crippled mess in a short period of

time. Thanks to Dr. Amstutz I am living life large again. Surgery

was a walk in the park and I resumed working ten days post op. I

workout every day, ride bicycles long distances, and I ran five

miles last week at a good pace with no problem and no pain only ten

weeks after surgery. I had my right hip done in May and I will wait

a year or longer for the left hip. I did see your email to me

directly and I will also respond to give you more details. I have

BCBS MA PPO. I speak with many people from the Boston area as well

as many others from all over the world. I am happy to assist you in

any way. It is the least I can do to repay the kind people here who

have been so supportive to me along the way. I will respond so we

can make direct contact.

Best... C+ Dr. Amstutz 5/04/04

> Hi,

>

> I am another in the growing list of new people to the group. I

want

> to thank all the existing members for the wealth of information

they

> have shared.

>

> Where I stand. I am a 46 years old - male. I was diagnosed with os

in

> both hips a few years back. Left side is way ahead of my right in

> degeneration. Used to be very active, jogging, tennis, softball,

> basketball...etc. It has, of course, progressed over the years to

the

> point where I need to walk with the assistance of a cane and now

> spend most of my time in a chair or on a couch. So, I have started

my

> journey down this road.

>

> I live outside of Boston and have contacted Drs. Amstutz, Gross

and

> Mont. Just like everyone else it seems, I am trying to get a

handle

> on the insurance aspect. Right now I have bc/bs HMO Blue New

England.

> My question is, has anyone had any success getting an HMO to pay

for

> this. I know certain local bc/bs have refused...CA and MD as 2

> examples. I have gotten varying reports. I need to know this

because

> I have an open enrollment in Sept and need to know what I should

get.

> I have the choice of various HMOs and PPOs. Any opinions on which

> might have the higher odds? I know there are members out there

that

> have had bc/bs of MA that have been covered but they were not

> specific to whether it was the HMO or PPO and what their co-pays

> were.

>

> Also, is there a list on here somewhere of all insurance cos that

> have paid and have refused? I think that might be beneficial to

new

> guys like me.

>

> Thank you all again,

>

> Ken

[Guest guest]

Ok this is great thank you all for responding...I am getting a

clearer picture...Grace just as an FYI...My take on bc/bs of MA is

this...they consider an EPO more as an HMO with more options...it is

different than their classic PPO plans. I think anything with Blue in

the name is bad...JMHO.

Also, alot of employers require that pre-exisiting conditions be

covered. That is the case with my company. So I would recommend that

people check this out.

I wish you and everyone here the best of luck and hope everything

works out for you.

Here are the descriptions from their web site:

Advantage Blue, an Exclusive Provider Organization (EPO), is

available to State Street employees located outside of New England.

Advantage Blue has been designed to provide benefits similar to those

found in an HMO, with a few exceptions.

Like an HMO, Advantage Blue provides coverage for medical care

services received through a network provider. There are no

deductibles and no coinsurance amounts. Authorized hospitalization is

covered in full; you pay a copayment for office visits and

prescriptions. Except for emergencies, there are no benefits

available for out-of-network care.

Advantage Blue does not require you to choose a primary care

physician (PCP) or obtain referrals. Advantage Blue utilizes the

BlueCross BlueShield PPO network.

Blue Care Elect Preferred, a Preferred Provider Organization (PPO)

plan, offers you the freedom and flexibility to receive care from

either an extensive national network of preferred medical providers

or from any other provider of your choice. When you join this plan,

you do not have to choose a primary care physician and no referrals

are necessary.

If you choose to receive care from a physician or a hospital within

the preferred provider network, you will receive full coverage at the

time of treatment. For certain services, such as inpatient hospital

stays, office visits, and prescription medication, you pay a

copayment depending on the service. If you seek treatment outside the

network, you will receive 70% coverage after satisfying an annual

deductible. Benefits for in-network services are based on rates

negotiated with the network providers. Out-of-network benefits are

based on usual and customary charges for the same or similar services

in your geographic area. (You will be responsible for any out-of-

network charges above usual and customary limits, as determined by

BlueCross BlueShield.)

The PPO plan allows you to determine your level of coverage based on

the providers you choose.

> > Hi,

> >

> > I am another in the growing list of new people to the group. I

> want

> > to thank all the existing members for the wealth of information

> they

> > have shared.

> >

> > Where I stand. I am a 46 years old - male. I was diagnosed with

os

> in

> > both hips a few years back. Left side is way ahead of my right in

> > degeneration. Used to be very active, jogging, tennis, softball,

> > basketball...etc. It has, of course, progressed over the years to

> the

> > point where I need to walk with the assistance of a cane and now

> > spend most of my time in a chair or on a couch. So, I have

started

> my

> > journey down this road.

> >

> > I live outside of Boston and have contacted Drs. Amstutz, Gross

> and

> > Mont. Just like everyone else it seems, I am trying to get a

> handle

> > on the insurance aspect. Right now I have bc/bs HMO Blue New

> England.

> > My question is, has anyone had any success getting an HMO to pay

> for

> > this. I know certain local bc/bs have refused...CA and MD as 2

> > examples. I have gotten varying reports. I need to know this

> because

> > I have an open enrollment in Sept and need to know what I should

> get.

> > I have the choice of various HMOs and PPOs. Any opinions on which

> > might have the higher odds? I know there are members out there

> that

> > have had bc/bs of MA that have been covered but they were not

> > specific to whether it was the HMO or PPO and what their co-pays

> > were.

> >

> > Also, is there a list on here somewhere of all insurance cos that

> > have paid and have refused? I think that might be beneficial to

> new

> > guys like me.

> >

> > Thank you all again,

> >

> > Ken

[Guest guest]

Hi ,

Thank you for responding. I really can't say too many times how kind

the people in this group are. I only wish some of it would trickle

over to the insurance companies. I think the best thing is knowing

that you are not alone in this. Sometimes I think, that I am the only

one to have his life taken away from him by this at such an early

age. You are an inspiration to me and I am sure to many others and I

want you to know it is greatly appreciated.

Ken

> > Hi,

> >

> > I am another in the growing list of new people to the group. I

> want

> > to thank all the existing members for the wealth of information

> they

> > have shared.

> >

> > Where I stand. I am a 46 years old - male. I was diagnosed with

os

> in

> > both hips a few years back. Left side is way ahead of my right in

> > degeneration. Used to be very active, jogging, tennis, softball,

> > basketball...etc. It has, of course, progressed over the years to

> the

> > point where I need to walk with the assistance of a cane and now

> > spend most of my time in a chair or on a couch. So, I have

started

> my

> > journey down this road.

> >

> > I live outside of Boston and have contacted Drs. Amstutz, Gross

> and

> > Mont. Just like everyone else it seems, I am trying to get a

> handle

> > on the insurance aspect. Right now I have bc/bs HMO Blue New

> England.

> > My question is, has anyone had any success getting an HMO to pay

> for

> > this. I know certain local bc/bs have refused...CA and MD as 2

> > examples. I have gotten varying reports. I need to know this

> because

> > I have an open enrollment in Sept and need to know what I should

> get.

> > I have the choice of various HMOs and PPOs. Any opinions on which

> > might have the higher odds? I know there are members out there

> that

> > have had bc/bs of MA that have been covered but they were not

> > specific to whether it was the HMO or PPO and what their co-pays

> > were.

> >

> > Also, is there a list on here somewhere of all insurance cos that

> > have paid and have refused? I think that might be beneficial to

> new

> > guys like me.

> >

> > Thank you all again,

> >

> > Ken

[Guest guest]

Hi ,

Thank you for responding. I really can't say too many times how kind

the people in this group are. I only wish some of it would trickle

over to the insurance companies. I think the best thing is knowing

that you are not alone in this. Sometimes I think, that I am the only

one to have his life taken away from him by this at such an early

age. You are an inspiration to me and I am sure to many others and I

want you to know it is greatly appreciated.

Ken

> > Hi,

> >

> > I am another in the growing list of new people to the group. I

> want

> > to thank all the existing members for the wealth of information

> they

> > have shared.

> >

> > Where I stand. I am a 46 years old - male. I was diagnosed with

os

> in

> > both hips a few years back. Left side is way ahead of my right in

> > degeneration. Used to be very active, jogging, tennis, softball,

> > basketball...etc. It has, of course, progressed over the years to

> the

> > point where I need to walk with the assistance of a cane and now

> > spend most of my time in a chair or on a couch. So, I have

started

> my

> > journey down this road.

> >

> > I live outside of Boston and have contacted Drs. Amstutz, Gross

> and

> > Mont. Just like everyone else it seems, I am trying to get a

> handle

> > on the insurance aspect. Right now I have bc/bs HMO Blue New

> England.

> > My question is, has anyone had any success getting an HMO to pay

> for

> > this. I know certain local bc/bs have refused...CA and MD as 2

> > examples. I have gotten varying reports. I need to know this

> because

> > I have an open enrollment in Sept and need to know what I should

> get.

> > I have the choice of various HMOs and PPOs. Any opinions on which

> > might have the higher odds? I know there are members out there

> that

> > have had bc/bs of MA that have been covered but they were not

> > specific to whether it was the HMO or PPO and what their co-pays

> > were.

> >

> > Also, is there a list on here somewhere of all insurance cos that

> > have paid and have refused? I think that might be beneficial to

> new

> > guys like me.

> >

> > Thank you all again,

> >

> > Ken

[Guest guest]

Hi, folks. I've been reading about all of the insurance stuff and I

certainly don't have answers for who covers what. But I know that Dr

Gross's office told me to let THEM handle the insurance part of it and my

insurance (United Health Care) covered the procedure. I lived in Kentucky

and had the insurance through my employer. I signed up for the " best "

coverage offered when we had our last open enrollment. Anyway, the

procedure took place in South Carolina -- obviously out of the immediate

area. I had to pay " out of area " expenses -- which came to less than

$2000, I think. But I got no crap about FDA approval, etc. Don't know if

that's specific to United Health Care of if it's the way Dr Gross's office

coded it. Whichever... it worked out. Thank God, because there's no way

I could have afforded the surgery without insurance. Joyce (Dr Gross, LHR,

2/2/04)

sungold518@...

Re: Hi - Yet another new guy from the Boston Area

Hi ,

Thank you for responding. I really can't say too many times how kind

the people in this group are. I only wish some of it would trickle

over to the insurance companies. I think the best thing is knowing

that you are not alone in this. Sometimes I think, that I am the only

one to have his life taken away from him by this at such an early

age. You are an inspiration to me and I am sure to many others and I

want you to know it is greatly appreciated.

Ken

> > Hi,

> >

> > I am another in the growing list of new people to the group. I

> want

> > to thank all the existing members for the wealth of information

> they

> > have shared.

> >

> > Where I stand. I am a 46 years old - male. I was diagnosed with

os

> in

> > both hips a few years back. Left side is way ahead of my right in

> > degeneration. Used to be very active, jogging, tennis, softball,

> > basketball...etc. It has, of course, progressed over the years to

> the

> > point where I need to walk with the assistance of a cane and now

> > spend most of my time in a chair or on a couch. So, I have

started

> my

> > journey down this road.

> >

> > I live outside of Boston and have contacted Drs. Amstutz, Gross

> and

> > Mont. Just like everyone else it seems, I am trying to get a

> handle

> > on the insurance aspect. Right now I have bc/bs HMO Blue New

> England.

> > My question is, has anyone had any success getting an HMO to pay

> for

> > this. I know certain local bc/bs have refused...CA and MD as 2

> > examples. I have gotten varying reports. I need to know this

> because

> > I have an open enrollment in Sept and need to know what I should

> get.

> > I have the choice of various HMOs and PPOs. Any opinions on which

> > might have the higher odds? I know there are members out there

> that

> > have had bc/bs of MA that have been covered but they were not

> > specific to whether it was the HMO or PPO and what their co-pays

> > were.

> >

> > Also, is there a list on here somewhere of all insurance cos that

> > have paid and have refused? I think that might be beneficial to

> new

> > guys like me.

> >

> > Thank you all again,

> >

> > Ken

[Guest guest]

Hi, folks. I've been reading about all of the insurance stuff and I

certainly don't have answers for who covers what. But I know that Dr

Gross's office told me to let THEM handle the insurance part of it and my

insurance (United Health Care) covered the procedure. I lived in Kentucky

and had the insurance through my employer. I signed up for the " best "

coverage offered when we had our last open enrollment. Anyway, the

procedure took place in South Carolina -- obviously out of the immediate

area. I had to pay " out of area " expenses -- which came to less than

$2000, I think. But I got no crap about FDA approval, etc. Don't know if

that's specific to United Health Care of if it's the way Dr Gross's office

coded it. Whichever... it worked out. Thank God, because there's no way

I could have afforded the surgery without insurance. Joyce (Dr Gross, LHR,

2/2/04)

sungold518@...

Re: Hi - Yet another new guy from the Boston Area

Hi ,

Thank you for responding. I really can't say too many times how kind

the people in this group are. I only wish some of it would trickle

over to the insurance companies. I think the best thing is knowing

that you are not alone in this. Sometimes I think, that I am the only

one to have his life taken away from him by this at such an early

age. You are an inspiration to me and I am sure to many others and I

want you to know it is greatly appreciated.

Ken

> > Hi,

> >

> > I am another in the growing list of new people to the group. I

> want

> > to thank all the existing members for the wealth of information

> they

> > have shared.

> >

> > Where I stand. I am a 46 years old - male. I was diagnosed with

os

> in

> > both hips a few years back. Left side is way ahead of my right in

> > degeneration. Used to be very active, jogging, tennis, softball,

> > basketball...etc. It has, of course, progressed over the years to

> the

> > point where I need to walk with the assistance of a cane and now

> > spend most of my time in a chair or on a couch. So, I have

started

> my

> > journey down this road.

> >

> > I live outside of Boston and have contacted Drs. Amstutz, Gross

> and

> > Mont. Just like everyone else it seems, I am trying to get a

> handle

> > on the insurance aspect. Right now I have bc/bs HMO Blue New

> England.

> > My question is, has anyone had any success getting an HMO to pay

> for

> > this. I know certain local bc/bs have refused...CA and MD as 2

> > examples. I have gotten varying reports. I need to know this

> because

> > I have an open enrollment in Sept and need to know what I should

> get.

> > I have the choice of various HMOs and PPOs. Any opinions on which

> > might have the higher odds? I know there are members out there

> that

> > have had bc/bs of MA that have been covered but they were not

> > specific to whether it was the HMO or PPO and what their co-pays

> > were.

> >

> > Also, is there a list on here somewhere of all insurance cos that

> > have paid and have refused? I think that might be beneficial to

> new

> > guys like me.

> >

> > Thank you all again,

> >

> > Ken