How can I make this happen?

[Seavey Hoops]

What's up hippy's? I was diagnosed with stage 3 bi-lateral hip arthritis at 25 years old... I'll be 27 in February - pretty bad situation for a professional basketball trainer. I work with Integrity Hoops, a training company for NBA players in the summer offseason & local youth players on my own in my area during the other months - my job requires me to be extremely active at all times, for several hours a day. These requirements have been impossible to meet in my condition & I've just about stepped away from basketball training entirely for the last 14 months. I'm also an extremely passionate basketball player myself & I'm hoping to get back the ability to play a couple hours a day at my peak performance. The one thing I love in life is something I can't do anymore... my long term career plans as an NBA player development coach are also in jeopardy. I don't have a college degree, so I don't have a suitable fall back option & I've already invested thousands of dollars into my Training career. Never did I think I would have severe hip arthritis in my mid-20's... you can't plan for this.

This past November, I was told I'm a perfect fit for Resurfacing by Dr. Edwin Su's office at HSS. Edwin Su is the IDEAL surgeon for me, in my opinion... he's very experienced, has very good long term outcome rates, is the only surgeon to return multiple arthritic-hip NBA players back to NBA competition, & he's somewhat local (I live about 4 hours away from HSS, no one else is closer). I see resurfacing as my only option due to my young age & because I've been told by multiple doctors(including Su's office) that a THR will not get me back to my high impact/activity lifestyle. I'm ok with a THR later in life, but 2 THR's at 26 is practically a death sentence in my field of work. I am committed to doing EVERYTHING in my power to get Hip Resurfacing. There is only 1 issue... money.

I'm still waiting to hear from Dr. Su's office manager to get a more clear picture on cost... I was quoted Su's surgical fee alone is 56k (28k a hip). This doesn't include the extra costs from HSS for an anesthesiologist, hospital room, follow up appointments down the road, etc. From what I can tell, Su only accepts a very limited selection of insurance plans, which are only accessible to certain employees in New York State. I live in New Hampshire & there isn't a single resurfacing surgeon in my entire state (I tried Dr. Moschetti at Dartmouth-Hitchcock, but he said he doesn't offer Resurfacing anymore due to a high amount of revisions for Metal Ion problems).

I currently have NH Medicaid for insurance - they don't allow me to see out of state doctors, but they DID approve a Prior Authorization in May 2020 for me to go out of state for Hip Arthroscopy. Unfortunately, the arthritis was too advanced to proceed with Arthroscopic surgery & the Arthroscopic specialist I was approved to see told me there'd be a 70% chance of failure 1 year post-op due to my arthritis. I expected to hear this bad news & decided to set my sights on Hip Resurfacing instead. I told this story to the physician's assistant from Dr. Su's office & he said the cost of Hip Arthroscopy is relatively comparable to Resurfacing, so it's plausible that my insurance would give another prior authorization for Resurfacing seeing as I didn't cash the first prior authorization in. Problem is, some places refuse to submit charges to out of state medicaid & I anticipate HSS is one of those places. I'm also open into getting a better, more flexible insurance plan like Cigna or Blue Cross to help me out IF that will do me any good (I'm not sure if it will).

Ok, now here's where I need some serious help - I anticipate Su's office manager will call me this week to talk about cost. I can't afford 56 thousand dollars, never mind the added HSS fees. I'm practically broke, I've been out of work for 14 months since my diagnosis & I'm in pretty debilitating pain, some days I can't even walk or sit more than 5 min. If it was a student loan type of payment plan that I pay back over time, I could definitely make this work once I'm healthy enough to resume my career, but from my understanding it doesn't work that way in the medical world: Su will need me to throw down a big chunk of change that I can't afford before he'll ever touch me. If I had the money I would spend it, no questions asked, even if it was my last dime - I NEED Hip Resurfacing surgery. I have no possessions to take a big loan out on - my car is a piece of shit & I rent an apartment. So, I've complained enough about what I CAN'T do & now I'd like to shift my focus to what I CAN do - I don't expect charity or sympathy, I know that EVERY patient Dr. Su sees must be in some sort of debilitating pain, so I'm not special here.

- What should I ask Dr. Su's assistant when she calls me?

- How can I make Hip Resurfacing feasible? I can't afford the full cost but this is something I need. I'm a perfect fit according to my age, sex, activity level & bone structure, so it sucks to have this invisible financial wall between me getting pain-free & living a normal life again.

- Does Dr. Su submit charges to out of network insurance companies IF they agree to accept the charges via Prior Authorization? This is what his website says but I'm still unclear: "Dr. Su participates with Oxford and United Healthcare insurance plans. Although Dr. Su is not an “in-network” provider with other plans, we will assist you in submitting all costs to your insurance."

- I do know HSS accepts most major insurance plans, but what can I expect the HSS costs to be? it's pretty clear to me that NH State Medicaid isn't going to cut it, so I will start looking into other insurance options ASAP.

- How do regular people get this surgery done by Dr. Su? He works with pro athletes & celebrities but his PA told me that he mostly works on regular, every day people (a lot from out of town). I figure I'm not the first person to run into these same financial problems?

- Is there a payment plan option? This would be easiest for me. if I could pay Su back over 5-10 years, I could definitely make this work somehow. I'm willing to do ANYTHING I can to make this happen & I figure it's going to be a battle, it's going to take a lot of effort on my part.

I appreciate you all for reading my rant & any answers you can give me. Patricia Walter is a HERO, this site is incredible. Not only is it loaded with more Resurfacing Info than anywhere else on the internet, but it's also comforting to know I'm not the only one suffering with this problem. The past 14 months have been the worst of my life, but this site gives me hope. For what it's worth, the good news is I have a pretty long window to get Resurfacing because of my young age/good bone structure... However, I'd like to be back to normal as soon as possible so I can enjoy life again & start advancing in my career again.

[jimbone]

Hoops-

Not having insurance coverage prevented me from going forward with surgery for the 3 years prior to absolutely needing it.  The last few months were as trying as your current condition, so like a lot of people here, I can relate.  My income at the time was impacted by an inability to function- I was in construction- and made me eligible for a Molina plan with WA State Health Care Finders.  I was not financially eligible for Medicaid due to assets and income.  Both my surgeries were done in the same year, 8 weeks apart- bilateral and my cost was the insurance deductible plus monthly premiums.  My surgeons fees were equivalent to Dr. Su's.  I based my insurance choice on the surgeons coverage acceptance.  It's been 3 years but IIRC my total out of pocket was around 10-12K including deductible and premiums, which was affordable due  to the  subsidies based on income level at that time.  I would have mortgaged the house or maxed my CC had it been necessary, fortunately it was not.

I'd suggest contacting the NH Health Care Providers to see if you qualify for subsidy of your premiums based on current income.  I would guess if you qualify for Medicaid you qualify for subsidy.  Then find coverage Dr. Su accepts and plan to take on a much smaller amount of debt.  You'd still be responsible for premiums and deductible but could probably make arrangements with the hospital to work out a payment plan- worth asking about.

The ACA's intention was to insure people get coverage, hence the subsidies and are not discriminated against for pre-existing conditions.  You should be able to make this work.  Best wishes.

[catfriend]

Good news, bad news. Open enrollment on the healthcare exchanges goes until January 15. You still have time to find a plan that will cover hip resurfacing, but I'm not saying that will be easy. Also, you may have to consider a resurfacing surgeon other than Dr. Su. Yes, Dr. Su is an excellent resurfacing surgeon, but so are Drs. Gross and Pritchett, and many others. It may boil down to finding an excellent surgeon who will accept your insurance. Since you already know you're an excellent candidate for resurfacing you might start by checking with the billing offices of a few of the top resurfacing doctors as to how they handle out of state billing and which insurances they accept. You will also need to go through each of the plans on your exchange and contact them to see how they handle out of state surgeries, etc. I don't mean contact the exchange, I mean contact the actual insurance companies. You need to find a match between a top resurfacing surgeon and the insurance available to you. I honestly don't know how this would work with NH Medicaid. Are you able to qualify for a subsidized exchange plan? If you were getting medicare (which you can get if you're on SS disability, but it takes a long time) that would be more portable.

Hip arthroplasty (THR) is the same billing code as resurfacing (which is considered another type of replacement) so if you can get an out of state arthroplasty approved then you're golden.

Many surgeons have payment plans, but I doubt any go out ten years. Some also have cash all inclusive options, although it sounds like that wouldn't work for you anyway. If you have a credit card with a high limit I would consider it.

NB: other top surgeons charge a lot less. Dr. Pritchett did both of my hips. I was without insurance for quite some time because of cost. I was to the point where I was going to sell my house and use part of the proceeds to pay for my second resurfacing (I was selling the house anyway). Thanks to covid, my income dropped low enough that I was able to qualify for a subsidized plan so I didn't have to go this route. However, since I was considering this, I did call Dr. P's billing office to discuss the cost. Without going into specific details I can't remember anyway I can tell you that the all cash package price for everything was less that Dr. Su's quoted fee for one hip.

If I were in your position I would spend the next week making it my full time job to find an insurance/surgeon match. I'm not saying it will be easy. It will be a hideous, tedious task that will be so frustrating you'll want to rip your hair out, but you just might be able to do it. Good luck.

[TotalWus]

Su is an outlier because of his very limited insurance options. That's why plenty of patients who are financially solvent and who do have substantial savings choose one of the other top surgeons instead of Su. It seems to me that someone in your situation who's decided that it must be Su is not unlike someone without any income or savings deciding that he must drive a $200K Rolls Royce because even a Mercedes won't do for him when plenty of people much better off are perfectly happy with a nice new, perfectly good $40K Toyota with all the bells and whistles that anybody really needs in a car.

There's probably nothing so unique about Su's procedure that means only he can give you a hip that will allow you to play ball again. If you research it, you'll probably find that other top surgeons have also returned professional athletes to their sports. Because of Su's reputation, it's also not unlikely that the reason he's the only surgeon whose patients have returned to the NBA is simply that NBA players chose him in the first place. Once he returned the first player to the NBA, other players were probably just much more likely to choose him. Don't take this wrong, but you're not actually in the NBA, either. You just need a hip that will allow you to be on the court as much as you want to be, which is very different from needing a hip that will allow you to perform to the level of an NBA player; and even that presuposes that Su provides a hip that's substantially better than the hips provided by any of the other top surgeons in the world, which, as I've suggested, is unlikely to be the case.

[LDub]

Hey Hoops

I agree with catfriend that finding a surgeon that works with your health provider is probably the first option to try. I'd also like to add a couple of other suggestions.

My wife and I have both had hip resurfacing procedures. My wife had her resurfacings done in 2009 and 2011 by Dr. Bose in India. It was a great experience (surgeon and surgery wise) and she has returned to all her previous sports (hockey, biking, hiking, gym, etc.) without issue. Those surgeries were ~7000 US dollars each. But you'd have to factor in air fare and accommodations. The hotels we stayed at were great and very inexpensive by western standards.

My surfacing is much more recent (last September) and was in Belgium with Dr. De Smet. My prosthetic is also ceramic, but I don't believe that would impact the cost of the surgery (in case you chose metal). The cost for me was 22.8K US dollars. But I did speak with a bilateral patient who said it was 36K US dollars for a bilateral. Again you will need to factor in flights and accommodations.

Both these surgeons are excellent. Their numbers speak for themselves. One advantage with Dr. De Smet is the option for ceramic. But you'll have to do your own research to make your own decision regarding metal vs. ceramic. Also, I have seen recent posts with people having some issues contacting Dr. Bose. I did contact him for a consultation last year and he did give me his advice. But I decided to go to Belgium for the ceramic.

I hope this helps a little. Best of luck.

LDub.

[stevel]

Hoops,

For my right hip resurfacing done 11/01/19, Aetna covered Dr Su, his PA and the Hospital for Special Surgery.
Medicare B covered the other physicians and pre-op labs and x-rays and Aetna covered as supplemental.
Aetna covers hip resurfacing alternative according to their clinical policy bulletin #0661 especially for those under age 65.
I only paid roughly $250 out-of-pocket for $100 K + billed surgical procedure.

I especially wanted another hip resurfacing as I'm an avid downhill skier, skiing nearly every day when there is fresh powder, skiing the steeps and backcountry.
Sometimes the lower joints endure impact from skiing moguls and drops but I also need the stability of the hip resurfacing joint and not be concerned about dislocation from a hard, twisting fall even from falling awkwardly into soft, deep powder!
The BHR hip resurfacing could potentially last my lifetime, the LBHR is over 13 years old and the RBHR is over 2 years old and I've been skiing every year all season as well as hunting and playing racquetball.

For your young age and activity level you must get a hip resurfacing somehow!!

[LarryBud]

How can I make it happen?

You can get a job that has insurance coverage.  I'd suggest a career which is not physically demanding to protect you hips for the next 60 years of life.

Don't overlook government work.  Good insurance and lots of opportunities.  Think about the long game.

[bluedevilsadvocate]

You might check with Dr. Brooks at Cleveland Clinic. Dr. Brooks is one of the top BHR surgeons. Cleveland Clinic is a non-profit academic medical center, and I think that the Cleveland Clinic accepts a very broad range of insurances.

[blinky]

You have received some great advice already. I have two ideas to add I did not see: 1) There used to be a program for people who could not afford a resurfacing. Any old timers remember its name? I thought it was advertised on Dr. Gross's website but I don't see it.  Was this DAST International? 2) If you enrolled as a student in a local college or uni would you be eligible to purchase low cost, high quality insurance? Part of me thinks this would achieve two goals, get you a degree so you could do more things and get you insurance. (I know you may answer "what? where am I supposed to get the money for all that????")