Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 I am a 38 year old professional with bilateral AVN. I am an engineer and have been researcing hip replacment options for the past year or so. I just found this site and have been reviewing the posts for the past few days. What a great source of information! I was about to start my surgeon search when an interesting or maybee distressing concept popped into my feeble mind. I had been reading some new postings when the concept of Dr's offices lying (maybee misleading) insurance companies has come about. A few years ago, my sister in law wanted some minor cosmetic surgery. Since elective surgery was not covered, the Dr's office listed it some special way so as not raise red flags and get approval. The surgey went fine and her insurance paid for everything. A few months later she got a call from her insurance company that they had conducted a random audit of her hospital and that her plastic surgeon had been caught improperly " coding " elective surgical proceedures. A few weeks later, she got a bill from the insurance company for the cost of the entire surgical proceedure. Well over 25,000 dollars. She had to hire a lawyer and eventually got it worked down to a reasonable figure. Has this type of situation been reported with this resurfacing proceedure? Why do some Dr's offices seem to get approvals all the time and others are always being denied? Does it vary by state? Boy does this throw a wrench into the works. I really dont want a regular hip replacement. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 Hey ! Glad you found us! Keep reading and you will realize that your concerns are the very same that all of us have or are working through. I'm glad you told us about your sister-in-law. What an annoying situation to deal with. Ugh! You will ultimately have to decide what is best for you. Many folks seem to work things out here in the US, some go to Belgium to Dr. DeSmet who is very experienced in re-surfacings (and who costs less than the US), some go to the UK where the procedure originated, some go to Australia, some Canada, and last but now least a few seem to end up in India where there is a resurf doc who trained in England (that doc is the least expensive of all). I wonder if there are resurf docs in non- English speaking countries? I'm curious if those folks have their own web-site like us but we don't know about it because we don't speak that language....hmmmm??!! Good luck with this very educational journey and ask us anything! Susie in Memphis > I am a 38 year old professional with bilateral AVN. I am an engineer > and have been researcing hip replacment options for the past year or > so. I just found this site and have been reviewing the posts for the > past few days. What a great source of information! > > I was about to start my surgeon search when an interesting or maybee > distressing concept popped into my feeble mind. I had been reading > some new postings when the concept of Dr's offices lying (maybee > misleading) insurance companies has come about. A few years ago, my > sister in law wanted some minor cosmetic surgery. Since elective > surgery was not covered, the Dr's office listed it some special way > so as not raise red flags and get approval. The surgey went fine and > her insurance paid for everything. > > A few months later she got a call from her insurance company that > they had conducted a random audit of her hospital and that her > plastic surgeon had been caught improperly " coding " elective surgical > proceedures. A few weeks later, she got a bill from the insurance > company for the cost of the entire surgical proceedure. Well over > 25,000 dollars. She had to hire a lawyer and eventually got it worked > down to a reasonable figure. > > Has this type of situation been reported with this resurfacing > proceedure? Why do some Dr's offices seem to get approvals all the > time and others are always being denied? Does it vary by state? Boy > does this throw a wrench into the works. I really dont want a > regular hip replacement. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2004 Report Share Posted July 8, 2004 Hey ! Glad you found us! Keep reading and you will realize that your concerns are the very same that all of us have or are working through. I'm glad you told us about your sister-in-law. What an annoying situation to deal with. Ugh! You will ultimately have to decide what is best for you. Many folks seem to work things out here in the US, some go to Belgium to Dr. DeSmet who is very experienced in re-surfacings (and who costs less than the US), some go to the UK where the procedure originated, some go to Australia, some Canada, and last but now least a few seem to end up in India where there is a resurf doc who trained in England (that doc is the least expensive of all). I wonder if there are resurf docs in non- English speaking countries? I'm curious if those folks have their own web-site like us but we don't know about it because we don't speak that language....hmmmm??!! Good luck with this very educational journey and ask us anything! Susie in Memphis > I am a 38 year old professional with bilateral AVN. I am an engineer > and have been researcing hip replacment options for the past year or > so. I just found this site and have been reviewing the posts for the > past few days. What a great source of information! > > I was about to start my surgeon search when an interesting or maybee > distressing concept popped into my feeble mind. I had been reading > some new postings when the concept of Dr's offices lying (maybee > misleading) insurance companies has come about. A few years ago, my > sister in law wanted some minor cosmetic surgery. Since elective > surgery was not covered, the Dr's office listed it some special way > so as not raise red flags and get approval. The surgey went fine and > her insurance paid for everything. > > A few months later she got a call from her insurance company that > they had conducted a random audit of her hospital and that her > plastic surgeon had been caught improperly " coding " elective surgical > proceedures. A few weeks later, she got a bill from the insurance > company for the cost of the entire surgical proceedure. Well over > 25,000 dollars. She had to hire a lawyer and eventually got it worked > down to a reasonable figure. > > Has this type of situation been reported with this resurfacing > proceedure? Why do some Dr's offices seem to get approvals all the > time and others are always being denied? Does it vary by state? Boy > does this throw a wrench into the works. I really dont want a > regular hip replacement. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.