Insurance Question

[prof]

Does anyone have Blue Cross / Blue Shield Carefirst insurance?  Their policy states they will only pay for resurfacing if the patient is 55 or younger.  What irony! My husband is 56 and had been told a couple of years ago that he would need a THR (that doctor didn't inform him of the possibility of resurfacing), so he has been pushing the pain to wait as long as he could.  If he had known about resurfacing then and had pursued it, apparently it would have been covered.  He is extremely active -- a runner all his life, boating, fishing, scuba diving, hiking, cycling, etc. and continuing these activities is of paramount importance to him, so definitely doesn't want THR.

His doctor's office (Dr. Mont, Baltimore) will not start the paperwork until 3 weeks before the surgery date, which means we won't be able to find out about insurance coverage until 1 or 2 weeks prior to the surgery.  My husband is a professor and must schedule the surgery during semester break, so if he's ultimately turned down for this surgery, and we decide to go overseas for it, he'd likely have to wait at least another 6 months if not a year in order to fit the surgery and nominal recovery time in between semesters.

I'm wondering if anyone with his type of insurance was turned down for age-related reasons but then was successful in getting approval?

[Pat Walter]

Hi

I am sorry you are having problems with your insurance company.  I have read a number of companies won't do resurfs for people over 55.  I don't know why.

I don't have insurance and sorry that I can't give you any help.  I just paid my way to Belgium to get my surgery.

You might want to post in the larger Yahoo Surface Hippy Group to see if anyone can help you there.  This is a small group since it is so new.  THere are over 6000 people on the Yahoo Group.  http://groups.yahoo.com/group/surfacehippy/


Dr. Mont is a very experienced and good surgeon.  I hope your husband will be able to have him do his surgery. 

If you should end up going overseas, please let us know.  I went to Belgium and my friend went to India.  So we can help with any questions.

Good luck with your insurance.  Your husband is still young and should have a hip resurfacing.  Just make sure he doesn't get an old fashioned THR with the small ball.  At least get a MOM if he has to go that route.  If I were his age, I would pay my way to India to Dr. Bose for $10,000 or $12,000 or go to Belgium to De Smet for $18,000   He is way too young to have a THR.  I was 61 when I had my hip resurfacing.

Pat in Ohio
3/15/05 LBHR De Smet

[cactuslady22]

Hi, I am using Mont also and was denied by BC/BS.  Very similar situation to yours.  You can contact me via my email at cactuslady22@yahoo.com   Maybe we can do something together.