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 , As you quickly learn, insurance approval or more correctly, insurance denial is a royal pain for most of us. It's a fair statement to say resurfacing OSs know there's huge exposure for improper statements on insurance filings and the one's I've been associated with aren't about to risk their livelihood trying to fudge it. I haven't seen any reports on this site like your sister-in-law, but I've only been a member for a year or so. To answer your question, insurance coverage and coding is something you need to take up with the individual surgeon or their administrator and get a comfort level with their process. Of the 9 or so US surgeons implanting the 'investigational' C+, I don't know that their insurance approval rates differ that much, but they might individually share their numbers. The BHR is not investigation but is not available in the US - you need to go overseas. A word of caution - one year can be a long time to make your decision. You should be aware that several people on this site have reported that once they were diagnosed as needing a resurfacing, they waited too long and their disease advanced to the point where they were no longer eligible for resurfacing and had to have a THR. Talk about throwing a wrench in the works... Dave C+ Amsutz, 2.24.98, 3.12.04 > 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...
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