Re: Is Insurance Covering Anyone?

[Guest guest]

,

The experience on this varies A LOT. One thing that could help is if

the FDA makes an approval. This is expected by the end of 2004 for the

C+ (but we can't know for sure, of course). If you think your insurance

_won't_ cover it as an investigational device, maybe it would be best to

wait until the decision is made by the FDA, then procede with the

insurance pre-approval filing/surgery date setting. As you say,

however, you have to balance that with your joint disease progression --

depends where it is currently -- any cysts beginning?

Good luck,

-

Is Insurance Covering Anyone?

Can anyone give me any info on insurance paying for resurfacing? I

would have to wait about 1 year to make sure they did not consider me

pre-existing. I'm not sure it is worth the wait, especially after

reading about some who waited too long and were no longer good

canidates for BHR. If I'm going to be denied anyway, perhaps I

should go ahead with the operation.

Your thoughts are greatly appreciated.

[Guest guest]

,

I was prepared to wait and live in pain and let the FDA, insurance

issues, etc., work itself out. The condition of my hip was far

worse than my limitations and tolerance. My window of opportunity

was narrow so I acted quickly and scheduled surgery prior to working

out the insurance.

As I understand it, insurance varies from company to company and

state to state, depending on plan, where you live, etc. I was one

of the fortunate ones and insurance covered my entire operation,

hospital, device, etc. I would stay close to your OS and keep a

close watch on your condition and progression and understand how

much time you have, or don't have as the case may be. My condition

was worse once they got in there relative to my recent x-rays.

I am pleased I took action and didn't miss this opportunity.

Best of luck.

C+ Dr. Amstutz 5/04/04

> Can anyone give me any info on insurance paying for resurfacing?

I

> would have to wait about 1 year to make sure they did not consider

me

> pre-existing. I'm not sure it is worth the wait, especially after

> reading about some who waited too long and were no longer good

> canidates for BHR. If I'm going to be denied anyway, perhaps I

> should go ahead with the operation.

>

> Your thoughts are greatly appreciated.

>

>

[Guest guest]

,

Who's your insurance? I'm with AETNA and they did ok by me.

C+ 4-15-04

> Can anyone give me any info on insurance paying for resurfacing?

I

> would have to wait about 1 year to make sure they did not consider

me

> pre-existing. I'm not sure it is worth the wait, especially after

> reading about some who waited too long and were no longer good

> canidates for BHR. If I'm going to be denied anyway, perhaps I

> should go ahead with the operation.

>

> Your thoughts are greatly appreciated.

>

>

[Guest guest]

,

Who's your insurance? I'm with AETNA and they did ok by me.

C+ 4-15-04

> Can anyone give me any info on insurance paying for resurfacing?

I

> would have to wait about 1 year to make sure they did not consider

me

> pre-existing. I'm not sure it is worth the wait, especially after

> reading about some who waited too long and were no longer good

> canidates for BHR. If I'm going to be denied anyway, perhaps I

> should go ahead with the operation.

>

> Your thoughts are greatly appreciated.

>

>

[Guest guest]

Hey ,

I have Blue Cross of CA, and originally I was told (or I understood)

that I was sh*t out of luck, and that BC wouldn't cover any portion

of the surgery. I later learned that JRI was going to submit the

procedure as a THA, disclosing " the device. " Apparently this has

been done before and ins has covered all with the exception of the

device ($12K of the $18K - the device, C+, is $6K). SOoooooo, I am

waiting myself on insurance. Though after reading post a few

back, I am going to email JRI and inquire about scheduling and

gettin' on the schedule (if not having surgery done) prior to

insurance accepting. I can pay some $ upfront if that's all it's a

matter of. I want to get a HIP already and MOVE on (literally), ya

know? Good luck to ya - that's my story, and I'm stickin' to it.

Alan on here is also waitin' on insurance...I think we'll be hearin

La Cucaracha at the same time!!! (inside JRI joke)....

...is that what you did? Paid upfront and then insurance paid

ya back? Please advise!!! Also, LOVED your post about the game,

and I'm with ... it IS the lil' stuff...the stuff most folks

take for granted. Personally I'm looking forward to sitting indian

style (been a dream for as long as I remember)...riding a

bike, ...etc etc...

In surfacehippy , " lsbtahoe " wrote:

Can anyone give me any info on insurance paying for resurfacing?

.............If I'm going to be denied anyway, perhaps I should go

ahead with the operation.

Your thoughts are greatly appreciated.

[Guest guest]

,

I have Blue Cross of CA and went through JRI for both my

resurfacings. BCCA approved and paid my 3/24/1998 resurfacing with

no problems, but my 2/12/2004 resurfacing was another story. Early

in 2002, Blue Cross initially denied my second resurfacing, claiming

they no longer covered investigational surgeries. This was a hard

pill to swallow, especially after I had great success with my earlier

resurfacing. I fought them for nearly 2 years, then, through

the efforts of JRI, they approved it. During that time I was growing

increasingly concerned that I was deteriorating to the point where I

would no longer be a candidate for resurfacing and would be left with

a THR. So I was naturally relieved at their approval. But after my

surgery, Blue Cross again reversed course and denied it. Even after

my attorney approved appeal letter (I has two insurance attorneys

eager to take my case), BCCA confirmed their decision to deny the

claim. But wait, there's more...BCCA ended up paying for much of

it even after saying they were going to deny it. Insurance in the

United States at its finest. Go figure.

The most knowledgeable person in this mess was Chuck , and

I'm ultimately pleased I followed his advice. He's

intimately involved with all the insurance issues, especially BCCA.

If it's any consolation, JRI has recently lowered their cash

price to approximately the same net cost as going to Belgium. BTW, I

have a group policy. The class action lawsuit against BCCA is

currently limited to individual policy holders.

Dave

> Can anyone give me any info on insurance paying for resurfacing?

> ............If I'm going to be denied anyway, perhaps I should go

> ahead with the operation.

>

> Your thoughts are greatly appreciated.

>

>

[Guest guest]

Hi ,

I have no experience with Unicare. You might do well to speak

with Chuck at JRI . He's in the middle of all the

insurance stuff, and he's a really nice guy. It has been strongly

recommended by many " experienced " hippies (why does that make me

think of Hendrix) that you NOT contact your insurance company

yourself. I followed their advice and had good success.

Good luck to you, and let us know how things go.

C+ Amstutz 4-15-04

>

>

> Thank you for your response. My insurance company is Unicare.

Have you

> heard anthing about them?

>

> Thanks,

>

>

>

>

>

[Guest guest]

Hey Dave, thanks for the info! I learned that Chuck IS the man

there! (not me, Beaule's asst) went to bat for me...so we'll

see what comes back! I heard about the class action, too...I too

have group coverage...so we'll see! I'm hopin' on at least them

covering ALL except for the device itself...we'll see!

Again, I appreciate the feedback!

In surfacehippy , " dm_griggzy " wrote:

> ,

>

> I have Blue Cross of CA and went through JRI for both my

> resurfacings.....

[Guest guest]

Hey Dave, thanks for the info! I learned that Chuck IS the man

there! (not me, Beaule's asst) went to bat for me...so we'll

see what comes back! I heard about the class action, too...I too

have group coverage...so we'll see! I'm hopin' on at least them

covering ALL except for the device itself...we'll see!

Again, I appreciate the feedback!

In surfacehippy , " dm_griggzy " wrote:

> ,

>

> I have Blue Cross of CA and went through JRI for both my

> resurfacings.....