Belgium BHR Costs

[Guest guest]

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

[Guest guest]

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