Dr Edwin Su - Out of Network Patient

[cisco.leon]

Hi Hippies,
I'm a 'hopeful' hip resurfacing candidate (32 year old male, basketball fanatic that has worn his hip into the ground). I have stage [insert worst stage] cartilage wear in my left hip. I had a micro-fracture surgery and joint debriment procedure in 2006. I was told this day would come. But it's about 20 years earlier than I thought.

I can no longer play basketball without pain (had to quit) and I my range of motion in my hip gets worse every week (sharp stabbing pains). I can no longer jog without a limp and mentally I am really in the dumps over the past 3-6 months.  :(

I have an appointment to see Dr Edwin Su May 20 2013. I am excited as I am terrified. I have a genetically shallow hip sockets and hoping that I am a positive candidate for the procedure.

Anyways I am with Blue Cross Blue Shield. Dr Edwin is not an in-network physician for me.

Has anyone else been treated by Dr Edwin Su out of network? If so please let me know:
1. What were your out of pocket expenses?
2. What was your experience with Dr Su?

I'm pretty set on Dr Su, from research he seems the best care I can possibly seek in NYC (where I live), but would love to hear experiences. Also, from a cost perspective I am really worried about the overall costs out of network. My insurance only covers 50% with no 'limit'.

Thanks so much guys!

[hernanu]

Hey leon, not a Su patient and have no financial info, but wanted to welcome you to the site.

It is terrifying as much as it is hopeful to have this. You'll be fine, Dr. Su is an excellent choice. Have you talked to the financial people in Dr. Su's office to see what can be worked out?

That may help.

[mustang4172]

Hello and welcome to the site.  You've come to the right place.  Dr. Su performed my bilateral hip replacement this past New Year's Eve.  I couldn't be happier at this point almost 4 mos. post op.  I didn't wear my hips out playing basketball.  I inherited my OA from my dad.   I've got about 20 years on you and I'm feeling very good - wondering why I waited as long as I did to have the surgery.

First of all, you're in great hands with Dr. Su.  He is a brilliant surgeon and probably one of the top five to perform this procedure in the world.  All my pre-op visits to his office and the HSS went very well.  And I had excellent care at the HSS during my three days there.

I also have BCBS, and was made aware up front by his administrators that I would probably have significant Out-of-pocket payments.  But, so far so good - up to this point I've only paid the 2K deposit for surgery out of pocket to Dr. Su as well as a portion of his initial consultation fee.  I still haven't received any other bills from Dr. Su or the HSS.  I'm still seeing the BCBS statements and recently sent in an appeal (authored by Su's billing partner and signed by me) requesting that BCBS compensate Dr. Su with more than they've paid so far.  Like I said, I haven't been billed - BCBS and Su's billing partners are still "fighting it out" as far as I can tell.
I know that I have to pay eventually, but honestly think it will be less than I expected.

You'll be made aware of Dr. Su's policy for out-of-network patients at your initial consultation.  I won't go into numbers here, but he gives you a pretty good option.

Please feel free to post any additional questions - be happy to help.

[cisco.leon]

Thanks for the replies and welcome guys.

Great to hear that there are 'options' for payment. I hope that bill doesn't arrive with an  astronomical $$$ figure on it :(

Hey hernanu:
I spoke to the admin staff and I was quoted $17,000 for the procedure. I mentioned that Dr Edwin's site says "out of network" patients will be treated and billed like in-network. But the administrator basically said, no we do not do BCBS in-network.

Maybe they are more revealing when I visit in person. I get that it may not be something they admit to over the phone.

Wow 4 months and you're already doing so well congrats mustang4172. Really happy for you. One thing I've learnt is that health is paramount, age means nothing if you're not healthy :) Seems like a simple lesson, but you don't really appreciate until you have something go wrong.

[mustang4172]

Cisco-

Glad I could help, but be advised that it's not a question of whether you will get any in-network benefits - Dr. Su is indeed out of the BCBS network.  The question is how much out-of-network benefits you will get from BCBS.  I'm in a PPO plan, so even if I see an out-of-network physician, I'm only supposed to be responsible for 30% of the total cost after the deductable is met.  But, even with that, I'm not necessarily guaranteed that figure for this particular procedure.  You may need to fight it out with BCBS to pay less out of pocket.  On the bright side, for the HSS, there shouldn't be an issue getting the maximum benefit that your plan allows.

[David]

Yea Cisco, work it out with the office first.  I was out of network, but my 80% paid a lot more than he gets from other insurances so I had zero out of pocket costs because he agreed to waive the remainder.
He is the best, or he did the best for me anyway.
1.5 years out and doing all I can do...
Running consistently 25m/week biking swimming and more...
His office staff is awesome...
Best...
David

[cisco.leon]

Thanks David.

My insurance said they will cover 50% with no cap on out of pocket expenses regardless of my deductibles for the year. So I think your 80% is basically IN-NETWORK coverage :) (I think my in network is covers 90% as a comparison).

David: did you mention the 'cost' thing directly with Dr Su or was it strictly with his admin staff?

[David]

I dealt with Christina who I'm sure got his approval for the acceptance of the insurance.

[chuckm]

Hey guys, I had surgery out of network at The Hospital for Special Surgery November 30th in 2012. My surgeon was done by Dr. Boettner (the other resurfacing specialist there). My insurance is Connecticare.

My plan has a 5K deductible and then covers 70% of expenses from there on. But, the question I could not get a straight answer on was how much would this ultimately cost.

The surgery expense was around $15,000.00 but that does not include all the other stuff, x-rays, anesthesiology costs, etc.

I'd say the whole enchilada for my left hip resurfacing was around $50,000.00 not including the rehab.
My rehab was local and in  the network so that was covered except for the $40 copay at each visit. 

Chuckm

[Khynes]

Hi Leon:

I too am going to have a hip resurfaced with Dr Su. My surgery date is set for Mid May.....wow just around the corner.
I am also struggling to get answers to insurance questions as this out of network for me. I have my insurance plan with Harvard Pilgrim.
I have been leaning on my employee advocate to find the answers to my insurance questions. It looks like I will be covered to the amounts specified in my plan pending a authorization process which the insurance Company is demanding. Dr Su needs to verify with the insurance Company that my surgery is necessary. Not sure if this is normal but have to comply.
I really believe that we have made the right choice going with Dr Su and that all of the effort will be well worthwhile.
I will let you know when I find out more about the insurance question.

All the best and good luck!

K.

[cisco.leon]

Hi Leon:

I too am going to have a hip resurfaced with Dr Su. My surgery date is set for Mid May.....wow just around the corner.
I am also struggling to get answers to insurance questions as this out of network for me. I have my insurance plan with Harvard Pilgrim.
I have been leaning on my employee advocate to find the answers to my insurance questions. It looks like I will be covered to the amounts specified in my plan pending a authorization process which the insurance Company is demanding. Dr Su needs to verify with the insurance Company that my surgery is necessary. Not sure if this is normal but have to comply.
I really believe that we have made the right choice going with Dr Su and that all of the effort will be well worthwhile.
I will let you know when I find out more about the insurance question.

All the best and good luck!

K.

K. how was your operation!???