Guest guest Posted June 23, 2004 Report Share Posted June 23, 2004 Wonder of Wonders! I just received a check from my insurance co. (CIGNA) for my BHR claim, and—-get this—-the check covers ~75% of what I paid Dr. De Smet, the Jan Palfijn Hospital, and the Holiday Inn Gent. I am simply stunned! After all, CIGNA had denied Dr. Beaulé's original request for pre-authorization to resurface my left hip—-and they twice denied my subsequent appeals. Anyway, for those of you who are considering having Dr. De Smet resurface their hip(s), here's a summary of my costs: Initial Payments for LBHR on 11/25/03 (reflects $-Euro exchange rates in effect last Oct & Nov): - Jan Palfijn Hospital: $8,389.88 (6,900 Euros) - Surgeon's Fee: $2,973.25 (2,500 Euros) - Lodging @ Holiday Inn Gent: $529.35 (425 Euros) - Treatment & Therapy: $594.70 (500 Euros) - Administration: $713.58 (600 Euros) - Total: $13,200.76 (10,925 Euros) Jan Palfijn Hospital Refund (received 3/1/04): $1,526.77 (1,269.24 Euros) Claim to CIGNA (submitted 3/23/04): $11,673.99 CIGNA Reimbursement (received 6/21/04) : $8,714.57 (74.65% of claim) Net BHR Cost: $2,959.42 Other BHR Costs: - Roundtrip Airfare (SFO–Brussels; Business Class): $2,306.40 - Misc Lodging, Transportation, & Other Costs: $307.84 Total BHR Cost: $5,573.66 Finally, the best news: My hip is fantastic! I have absolutely no limp (but I do have some hip flexor pain), and there's a bonus: I'm playing racquetball again. So, even if CIGNA had denied my claim, I would still consider my decision to go to Belgium one of the best decisions I've ever made... Jim V.S. LBHR, De Smet, 11/25/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2004 Report Share Posted June 24, 2004 Jim... I'm waiting for the word from CIGNA on my own predetermination. I am expecting a denial, though am told a couple of hippies have convinced the company to pay for the procedure, but not the device... In any case, I'd be curious to know how you even filed the claim with CIGNA for non-emergency care outside the country. Thanks, Alan > Wonder of Wonders! I just received a check from my insurance co. > (CIGNA) for my BHR claim, and—-get this—-the check covers ~75% of > what I paid Dr. De Smet, the Jan Palfijn Hospital, and the Holiday > Inn Gent. I am simply stunned! After all, CIGNA had denied Dr. > Beaulé's original request for pre-authorization to resurface my left > hip—-and they twice denied my subsequent appeals. > > Anyway, for those of you who are considering having Dr. De Smet > resurface their hip(s), here's a summary of my costs: > > Initial Payments for LBHR on 11/25/03 (reflects $-Euro exchange rates > in effect last Oct & Nov): > > - Jan Palfijn Hospital: $8,389.88 (6,900 Euros) > - Surgeon's Fee: $2,973.25 (2,500 Euros) > - Lodging @ Holiday Inn Gent: $529.35 (425 Euros) > - Treatment & Therapy: $594.70 (500 Euros) > - Administration: $713.58 (600 Euros) > > - Total: $13,200.76 (10,925 Euros) > > Jan Palfijn Hospital Refund (received 3/1/04): $1,526.77 (1,269.24 > Euros) > > Claim to CIGNA (submitted 3/23/04): $11,673.99 > > CIGNA Reimbursement (received 6/21/04) : $8,714.57 (74.65% of claim) > > Net BHR Cost: $2,959.42 > > Other BHR Costs: > > - Roundtrip Airfare (SFO–Brussels; Business Class): $2,306.40 > - Misc Lodging, Transportation, & Other Costs: $307.84 > > Total BHR Cost: $5,573.66 > > Finally, the best news: My hip is fantastic! I have absolutely no > limp (but I do have some hip flexor pain), and there's a bonus: I'm > playing racquetball again. So, even if CIGNA had denied my claim, I > would still consider my decision to go to Belgium one of the best > decisions I've ever made... > > Jim V.S. > LBHR, De Smet, 11/25/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2004 Report Share Posted June 24, 2004 Jim... I'm waiting for the word from CIGNA on my own predetermination. I am expecting a denial, though am told a couple of hippies have convinced the company to pay for the procedure, but not the device... In any case, I'd be curious to know how you even filed the claim with CIGNA for non-emergency care outside the country. Thanks, Alan > Wonder of Wonders! I just received a check from my insurance co. > (CIGNA) for my BHR claim, and—-get this—-the check covers ~75% of > what I paid Dr. De Smet, the Jan Palfijn Hospital, and the Holiday > Inn Gent. I am simply stunned! After all, CIGNA had denied Dr. > Beaulé's original request for pre-authorization to resurface my left > hip—-and they twice denied my subsequent appeals. > > Anyway, for those of you who are considering having Dr. De Smet > resurface their hip(s), here's a summary of my costs: > > Initial Payments for LBHR on 11/25/03 (reflects $-Euro exchange rates > in effect last Oct & Nov): > > - Jan Palfijn Hospital: $8,389.88 (6,900 Euros) > - Surgeon's Fee: $2,973.25 (2,500 Euros) > - Lodging @ Holiday Inn Gent: $529.35 (425 Euros) > - Treatment & Therapy: $594.70 (500 Euros) > - Administration: $713.58 (600 Euros) > > - Total: $13,200.76 (10,925 Euros) > > Jan Palfijn Hospital Refund (received 3/1/04): $1,526.77 (1,269.24 > Euros) > > Claim to CIGNA (submitted 3/23/04): $11,673.99 > > CIGNA Reimbursement (received 6/21/04) : $8,714.57 (74.65% of claim) > > Net BHR Cost: $2,959.42 > > Other BHR Costs: > > - Roundtrip Airfare (SFO–Brussels; Business Class): $2,306.40 > - Misc Lodging, Transportation, & Other Costs: $307.84 > > Total BHR Cost: $5,573.66 > > Finally, the best news: My hip is fantastic! I have absolutely no > limp (but I do have some hip flexor pain), and there's a bonus: I'm > playing racquetball again. So, even if CIGNA had denied my claim, I > would still consider my decision to go to Belgium one of the best > decisions I've ever made... > > Jim V.S. > LBHR, De Smet, 11/25/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2004 Report Share Posted June 25, 2004 Hi Alan, If CIGNA denies JRI's request for pre-determination in your case, then you'll have to decide whether to proceed w/ the surgery @ JRI or go to Belgium for a BHR. As for surgeon skill and quality of care, I don't think it matters much whether Dr. Amstutz or Dr. De Smet resurfaces your hip. However, your final cost depends on how much, if any, CIGNA reimburses your costs. I suppose it's possible that CIGNA may be more likely to reimburse some of your costs if you go to JRI (vice Belgium), but I made my decision based on the assumption that CIGNA wasn't going to reimburse one single penny of my costs. Please note that if you assume you have better chance of getting some of your costs reimbursed by going to JRI, your final cost may still be more than if you had gone Belgium and CIGNA not reimbused any of your costs. Bottom Line: The way CIGNA does business, your decision is pretty much a crap shoot... BTW, I submitted my claim per CIGNA's prescribed procedure. Jim V.S. LBHR, De Smet, 11/25/03 > > Wonder of Wonders! I just received a check from my insurance co. > > (CIGNA) for my BHR claim, and—-get this—-the check covers ~75% of > > what I paid Dr. De Smet, the Jan Palfijn Hospital, and the Holiday > > Inn Gent. I am simply stunned! After all, CIGNA had denied Dr. > > Beaulé's original request for pre-authorization to resurface my > left > > hip—-and they twice denied my subsequent appeals. > > > > Anyway, for those of you who are considering having Dr. De Smet > > resurface their hip(s), here's a summary of my costs: > > > > Initial Payments for LBHR on 11/25/03 (reflects $-Euro exchange > rates > > in effect last Oct & Nov): > > > > - Jan Palfijn Hospital: $8,389.88 (6,900 Euros) > > - Surgeon's Fee: $2,973.25 (2,500 Euros) > > - Lodging @ Holiday Inn Gent: $529.35 (425 Euros) > > - Treatment & Therapy: $594.70 (500 Euros) > > - Administration: $713.58 (600 Euros) > > > > - Total: $13,200.76 (10,925 Euros) > > > > Jan Palfijn Hospital Refund (received 3/1/04): $1,526.77 (1,269.24 > > Euros) > > > > Claim to CIGNA (submitted 3/23/04): $11,673.99 > > > > CIGNA Reimbursement (received 6/21/04) : $8,714.57 (74.65% of > claim) > > > > Net BHR Cost: $2,959.42 > > > > Other BHR Costs: > > > > - Roundtrip Airfare (SFO–Brussels; Business Class): $2,306.40 > > - Misc Lodging, Transportation, & Other Costs: $307.84 > > > > Total BHR Cost: $5,573.66 > > > > Finally, the best news: My hip is fantastic! I have absolutely no > > limp (but I do have some hip flexor pain), and there's a bonus: > I'm > > playing racquetball again. So, even if CIGNA had denied my claim, > I > > would still consider my decision to go to Belgium one of the best > > decisions I've ever made... > > > > Jim V.S. > > LBHR, De Smet, 11/25/03 Quote Link to comment Share on other sites More sharing options...
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