Questions about being a proper resurfacing candidate...

[Tri Hard Alan]

You have a bit over 4 months to get yourself into the best pre-surgery shape possible. A triathlete friend of mine who had bilateral surgery with Dr. Su in NY told me to get myself into the best shape I could as it would facilitate a good recovery.

Couldn't agree more. I carried on racing Triathlons and with the help of a program from my physio did a lot of strengthening exercises, lost some weight and it worked very well. I was back running at 4 months and doing Sprint Triathlons at 7 months. Next week I will be doing my first Olympic Triathlon at 9 months.


Good luck!

[Joe_CA]

Thanks for the well wishes and advice to get myself in shape Quig and Alan. I have remained active via weight training, some cardio, and continued sand volleyball (though my level of play is now rather sad given my hips). Besides general overall conditioning and strengthening, is there any specific exercises or group of muscles that I should concentrate on in the next couple of months? For example, I still try and work my lower body via weights (squats, leg extensions). I say "try" because these are getting harder to do as the years go by, and my ROM worsens.

I would love to get any where near the level of recovery both of you have. Your stories are inspiring for sure.

[LMS]

Here are the exercises that if nothing else, they encourage us to do:


Lying on back:


With rolled up towel under neath knee, leg straight, push back of knee/leg onto floor
With same towel, same spot, lift lower leg up to straighten leg.
Slide heel toward body, bending at knee
Slide straight leg away from body.
With both legs straight, clench glutes/butt squeeze


So, taking these in mind, if you can do the variations of these standing up, do them.  They were what we did pre & post surgery.  Oh ...


Going up on toes & half squats.

[karlos.bell]

 :) It is a massive hard task Joe to keep the joint moving when it freezes up. Do anything you can that works to keep the ROM up and the joint moving.......... It depends also where the major of the issue is. Anterior, posterior or just weight bearing. From my experience of a Bilateral it is the year after how to get it back into shape. I did 21 k the other night plus now 6 k the last 3 days. Just to give the muscles the shock of there life and the tendons that have been inactive for so long to step up........ It is working.... Exercise... Nutrition... rest.... Exercise... Etc.... So there is no easy fix to keep it going just do what you can. Glut Max do help but mine gave in years ago now just finally getting some butt muscle back... It is hard work anything you can ... Cheers K 8)

[John C]

Hi Joe. In support of what Chuck and others have said, here is my amateur understanding of why being bone on bone makes you a good candidate for a resurfacing. You should check my details, but I believe that as a hip joint progresses to bone on bone, the body changes the blood supply routes to the femoral head. This change in blood supply routes is important to a successful resurfacing, which is why many of the top resurfacing surgeons will ask people to wait if their arthritis has not progressed far enough yet. I think you can wait too long, which is often related to the presence and size of cysts on the femoral head. My hip was bone on bone with cysts, but Dr Gross was able to fill the cysts in with bone graft which is standard for him, and 8 years later things are still going great.

[Joe_CA]

Uh oh. Bad news. I was scheduled to have bilateral hip-resurfacing with Dr. Gross this December. I have done all the pre-certification medical tests for clearance, flew out to SC for the initial evaluation, got approved time off work, made the airline and hotel reservations, and was truly looking forward to benefitting from this wonderful procedure. It's been 6-7 months since I started the process, and even though I was a little scared, I was more than ready.

Of course, the *very first* issue I believed I had resolved was to make sure that my medical insurance covered this procedure, as I didn't want to waste my time, nor the time of the medical staff. I put in the request to Dr. Gross's staff to run my insurance number to verify coverage. I was a little shocked, but even though Dr. Gross is an out-of-network physician, the results were 100% coverage, and no out-of-pocket expenses. Even with this seemingly legitimate approval, I double-checked my coverage with the staff at Dr. Gross' office when I have my initial evaluation a few weeks ago. With that huge hurdle out of the way, I started down the path to finally getting something done about these hips.

Several days ago, I received a call from Dr. Gross's office. When they re-ran my insurance coverage, they were told this time that I didn't have coverage (this time they stated I have no out-of-state benefits). Without going into too many details, I was originally told by my medical group that I would have to find a surgeon on my own though my insurer, since my medical group doesn't perform hip-resurfacing.  I am now stuck in the Catch-22 situation where my insurer won't approve it until my medical group does, and my medical group continues to tell me to work through my insurer. I have one last Hail Mary play, where I can have my PCP submit a request for this surgery, and see if it gets authorized (unlikely).

Anyway, I'm upset at these last minute circumstances, and please let my story be a warning to others to please verify their coverage independently on your own, perhaps several times to confirm your coverage. This is something I failed to do. I guess my excuse was I didn't know the specific procedure and hospital codes, and wasn't sure if I would complicate matters. I should have been more proactive with this.

I'm still staying positive overall however. And that is because while I may have been set back 6-12 months from getting to a pain-free existence, and on the path towards healing and being active again, I know that I will eventually have this surgery done, and will be able to report of my own success story someday.

[Quig]

Damn, what a mess. I'm so sorry to read this Joe.


I wish I could offer some advice on how to fix it but I don't have a clue. Don't give up! I sincerely hope you can get this resolved and get yourself some new pain free hips. Good luck!

[horse doc]

That stinks. 

What steps do you think you skipped?  Do you need to get something in writing from insurance before knowing you will be covered?  What insurance do you have, an HMO?

I'm sort of in the same situation about being reluctant to contact insurance company on my own fearing I would say the wrong thing.  I've left it up to the office staff so far.

I've never had to get an approval since the only times I had to have surgery have been in emergency situations until now.  I don't really have a PCP, have just gone straight to orthopedic surgeons for opinions.

[Joe_CA]

Thanks Quig. I've always appreciated your kindness, support and wealth of information regarding your experience. I will keep fighting. Regardless of the outcome of this setback, I know that I will someday have new hips done by an experienced surgeon, even if it ends up being someone other than Dr. Gross.

HorseDoc - I'm not exactly sure what I've could have done differently. I keep going back, trying to reassess how  this played out. I checked for insurance coverage via the staff Dr. Gross back in July, and then because I was paranoid, I double checked with them in October. Everything seemed okay. When they ultimately ran the authorization for the actual surgery a week ago, it was declined. I don't think my insurance would have provided me any written statements of coverage.

I looked at your posts, since you stated you were in a similar situation. It sounds like you were in the exact situation I am now in. It sounds like you were able to bump your situation to the medical director at Blue Cross/Blue Shield (BCBS), and you ultimately got them to approve your surgery. Great job. I might private message you to see what steps I can take.

My insurance is an HMO through BCBS, and Dr. Gross was one of the few who accepted my insurance. I previously looked into mostly all experienced surgeons in California, and they all stated they didn't take HMO insurance. So I'm somewhat in a bind, since they don't have surgeons with hip-resurfacing experience at my medical group (I have recently heard that there's one guy in the medical group who has done a grand total of *three* HRA procedures in the last *seven years* - no way I want to be the guinea pig for that particular surgeon :-))

Thanks,
Joe

[catfriend]

Joe - Open Enrollment for insurance starts today. I suggest you very carefully comb through available plans and find one that will cover this surgery with your doctor of choice. It may cost more than your current plan, but will be worth it. After my consultation with Dr. P last Christmas Eve I called up my insurance company and bumped my policy up to the highest level offered so I could benefit from the lower deductible and max out of pocket. Higher premiums, but worth it considering the costs of surgery, pt, etc.

[Joe_CA]

Thanks catfriend. This was something I was seriously considering back in the Summer. If I didn't already believe I had an authorization, I would have probably switched to the Kaiser medical group here in California (and would have been able to choose Dr. Klug, who is an experienced hip-resurfacing surgeon).

Unfortunately, the open enrollment period was closed several weeks ago through my employer. It's kind of sad (and humorous!) how all these little events kind of lined up, just at the right/wrong time for me. Oh well, I have to keep my spirits up, since that's the only thing I have going for me right now! :-)

[Joe_CA]

Hi everyone,

I'm still fighting the good fight in terms of trying to get my hip resurfacing denial overturned. Things aren't going great, but I'm not giving up just yet, and will go down swinging. My contention is my medical group truly doesn't have even a remotely acceptable candidate who does the procedures. I reached out to Pat earlier with my question below in a personal message. I then thought of the rest of the this group have proven to be a invaluable source of information, so why not ask anyone willing to listen. Thanks.

***********************************************************************************
Hi Pat,

I'm still in the exhaustive process of appealing my medical group's decision to go outside their network and find an experienced hip resurfacing surgeon like the ones listed on your site, with a minimum of several hundred procedures. Believe it or not, they are trying to say that an orthopedic surgeon who is in my medical group is available to me, even though he's done no more than *3-4* hip resurfacing procedures in *5-7* years, and isn't even an believer in hip resurfacing (he tried to talk me out of it with some not so subtle scare tactics, and into a total hip replacement).

Do you have any research literature, or any form of other documentation I could cite to add to my appeal in regard to the relative complexities of hip resurfacing versus a THR, and benefitting from using a surgeon who has experience and not be a guinea pig to a surgeon who doesn't even believe in the successes of hip resurfacing?

Thanks,
Joe

[Pat Walter]

I thought I would post my answer to you in case someone else might be interested:

Here are some appeal letters.  Maybe they will help.  Many are old, but not much has changed

http://surfacehippy.info/insurance-appeal-letters-and-information/

Here are some medical studies about doctor experience and outcomes of hip resurfacing.

http://surfacehippy.info/category/medical-studies-general-hip-resurfacing-studies/medical-studies-doctor-experience-learning-curve-studies/


I hope that helps. 

If anyone knows of additional information, I would be happy to post it on the website.

Pat

[Wyoming Kim]

I hope your able to get something worked out to your satisfaction.

[Joe_CA]

Update:

Finally some good news. I've been authorized for my bilateral surgery with Dr. Gross for next week! I'm so happy right now I can barely contain my emotions. I'd like to be able to say that logic and reason won out and that my appeal was granted, and the powers that be understood my need for hip-resurfacing, and my choice to go out of my medical group since the only surgeon in my group has done a mere handful of resurfacing procedures. I wish I could say that (the appeal is actually still pending).

I believe I had something similar to a guardian angel here in the HR/Benefits department at my employer, who sympathized with my plight. I had to meet her in person and explain my situation. There's a chance she felt sorry for me, seeing how I was hobbling around and such. Anyway, to make a long story short, I was miraculously able to get my insurance changed to a PPO, effective at the first of this month. After that, things started falling in place.

So I will soon have my own story to share here. I again want to thank Pat and all the others here who share their stories and give the much needed advice and support. If I didn't somehow stumble on to this site, I don't know where I'd be right now.

[Quig]

Awesome news Joe!! It sure is nice when a story has a happy ending.


Best of luck with your surgeries, and enjoy your time in SC. I'm looking forward to hearing how things go. I have no doubt everything will go well, you're in GREAT HANDS with Dr. Gross and his crew. 

[blinky]

Great news! I am so glad this worked out.


Yes, can't wait to hear your story.

[Joe_CA]

Thanks Quig and Blinky. I've always appreciated your well-wishes and advice. And soon I will join an even more exclusive group here which you two are already members (bilateral/same week with Dr. Gross). :-)

[horse doc]

Congratulations!   All the persistence will be well worth it.

[Joe_CA]

Hi everyone! As of 1:00 PST yesterday, I am an official bilateral recipient of two brand new hips (performed by Dr. Gross). Everyone who responded to my questions were completely correct. Dr. Gross and his staff are highly professional and  very nice. I believe I have made the right choice. I only brought a small tablet to send messages, so I will wait until I get home to share my experiences. So far, I am completely satisfied with my decision. Thank you all.