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Author Topic: BCBS Coverage?  (Read 2096 times)

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triathloner

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BCBS Coverage?
« on: July 14, 2008, 08:37:11 PM »
I am posting in the General in hopes that enough people may see my insurance question.  I am planning on going through with a BHR with DR Rogerson in Madison, Wi. sometime this fall.  I have heard a lot of good things about their facility.  They do not accept blue cross and blue shield, so I am looking at out of network charges.  My policy is pretty good so my max out of pocket will be around $3000.  I know BCBS can be hard to deal with, and I am wondering if anyone has any advice on dealing with them.  I don't really want to switch doctors, but may be open to others close to me if they are in network and good at what they do.  I live in Northern Minnesota so I would like to be in the Midwest if possible.  Thanks for your help with my decision.  Al.
left biomet Dr. Gross 10-22-08

Tarhoo2

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Re: BCBS Coverage?
« Reply #1 on: July 15, 2008, 02:03:58 AM »
Don't know if this is helpful or not, since my doctor does accept BCBS, but my BCBS PPO covered both my BHR's, apparently with no questions.  Good luck in resolving your situation.

xocy

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Re: BCBS Coverage?
« Reply #2 on: July 15, 2008, 03:31:25 AM »
The problem you will have is when using an out of network provider, you will be responsible for the difference between what your provider charges and the charge ALLOWED by BCBS. This is in addition to your out of pocket maximum.

Mike
Mike
Bilateral
Dr. Thomas Gross
Left 6/23/08  Right 6/25/08

triathloner

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Re: BCBS Coverage?
« Reply #3 on: July 15, 2008, 02:54:11 PM »
Yes Mike, your right on, I just got off the phone with Dr. Rogerson's office and they want $6200 up front even with insurance for the balance bill portion.  Looks like they are out which is too bad because I've heard good things about them.  I just can't afford to stare down 10 grand  total right now if I can find someone in network. 

Next question, does anyone know who does the BHR procedure who si in the BCBS network?  Any replies are appreciated.  Anywhere in the country even I can buy a few plane tickets 10,000.  Thanks. Al.
left biomet Dr. Gross 10-22-08

xocy

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Re: BCBS Coverage?
« Reply #4 on: July 15, 2008, 04:32:40 PM »
I had mine (bilat) with Dr. Gross in Columbia, SC. His video is here on this web site and on there is more info on his web site www.grossortho.com. If you have a BC PPO, they will probably allow you to go there. He uses a small boutique hospital and there is a Marriot Courtyard in the parking lot (literally). The hospital gives a 20% discount on your share of the bill if you pay prior to admission, so a patient needs to let them file before any other providers to maximize your discount.

I'm recovering rapidly and I'm 20 days post op and feeling good. I'm getting better everyday.

Mike
Mike
Bilateral
Dr. Thomas Gross
Left 6/23/08  Right 6/25/08

marathonhippo

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Re: BCBS Coverage?
« Reply #5 on: July 15, 2008, 08:18:52 PM »
I too have BCBS, and here is what I did:  I first went here -  http://www.birminghamhipresurfacing.com/
and put in my zip code to find a BHR surgeon.  They list them within a fairly large radius.  Next I went to the BCBS website and clicked on the “locate a doctor” link.  I was able to find a doctor and hospital that accepted BCBS within 40 miles of my home.  My insurance is BCBS of Minnesota, because my company is based there, but I'm in Utah.  I went through 2 BHR surgeries 5 weeks apart, and have had no problems whatsoever with insurance.  My policy is a PPO, and I have no problem using it in Utah at all.  They have been great to work with and have paid everything without question.  I had about $3000 out of pocket total for both surgeries, and since I did that early in the year, the rest of the year is basically free since the OOP max has been met.

Good luck with everything.  I'm over 6 months out with the 1st surgery, and 5 weeks less than that with the second, and I am to the point I don't think much about my hips anymore because they feel pretty normal.  I assume from your name that you're an athlete, and I try to be, but I'm waiting until my 1 year anniversary before I'll try to run at all.  I think resurfacing is definitely the way to go, so keep searching, and keep us posted.


Alan
RBHR  2/4/2008 - LBHR 3/10/2008 Dr. Hickman

TomBuell

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Re: BCBS Coverage?
« Reply #6 on: July 15, 2008, 09:11:46 PM »
I'd find a doctor who was in-plan. I had my RBHR 2 weeks ago and it was covered 100 pct by my BCBS. I know rules differ state to state (I'm in Pittsburgh, PA, where BCBS goes by Highmark) but it seems like there are plenty of good in-plan docs around.
Good luck, you'll be glad you did it.
- Tom

triathloner

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Re: BCBS Coverage?
« Reply #7 on: July 16, 2008, 01:36:58 PM »
Marathonhippo-  I am in the same process of researching doc's the same way you mentioned.  Were you able to find an experienced doctor in your area?  Mostly what I am finding are doc's who have done only a handful.  My big scare is at 38 yrs old I will end up with a THR instead of a BHR if I don't find a doc who is more experienced.  I am so glad to hear stories like yours where you are feeling normal after 6 months, I just can't imagine it,  Like not grabbing my pants leg to swing my left leg into the car upon entry, and not having to sit on a chair to get my sock on.  I was thinking about the same as you about the 1 year timeframe.  I don't plan on running a lot but would like to the the local triathlon each year.  I guess I plan to do more of my training through water running, or on an elliptical in the future. 
left biomet Dr. Gross 10-22-08

xocy

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Re: BCBS Coverage?
« Reply #8 on: July 16, 2008, 02:19:15 PM »
Can you find a cheap air fare to Columbia, SC? If someone is coming with you, the Marriott at the Hospital is $92.00 per night. If you want to really save, you might try flying to Atlanta (many cheap fares) rent a car and drive to Columbia which is about 3 hours.

I am 59 and am 21 days post op. I've just about thrown the cane away. AND I'M A BILAT. I HAD TWO OF THESE THINGS ! I'm not perfect yet, but I can tell he did a good job. My incisions are under 4" each.

Dr. Gross will diagnois you by looking at your x rays via fax, email, or snail mail. He is on vaction right now, but his clinical nurse Nancy will speak to you.

I'd consider the trip.

MIke
Mike
Bilateral
Dr. Thomas Gross
Left 6/23/08  Right 6/25/08

triathloner

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Re: BCBS Coverage?
« Reply #9 on: July 16, 2008, 03:59:57 PM »
I am considering the trip.  What is the schedule there.  how many days in the hospital and how many extra did you end up being in the area.  Just trying to grasp the amount of time I would need to spend there.  Thanks for your help. 
left biomet Dr. Gross 10-22-08

xocy

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Re: BCBS Coverage?
« Reply #10 on: July 17, 2008, 02:47:35 AM »
He typically does surgery on Monday and Wednesday. I had two done so I came to Columbia Sunday evening, had the left done Monday, the right done Wednesday, and went home on Friday around lunch time.

If you are doing one hip and don't want to meet him way in advance requiring two trips, I suspect you will meet at his office on Tuesday, surgery on Wednesday, go home on Thursday. This is typical. Of course if you have some complication, all bet are off. The Marriott is in the hospital parking lot. My wife stayed there and walked over to her hospital everyday. The rate at the Marriott is $92 per night with the hospital discount.

He is on vacation, as is his Nurse Practitioner, Lee Webb. Ordinarily you can call her on her cell phone, but I have no idea if she answers on vacation. I found it rather amazing that she publishes her cell number on the web site.
Nancy Smith is in the office now and she is a delight. You can call her tomorrow. If you get her voice mail, leave a message, she is good about returning calls.

I was a nervous wreck worrying about the pre-op. I'm claustrophobic and I feared that the situation of losing control might make me go "ape". I got thru it fine. The pre-op staff at the hospital was great.

My right hip is not doing as well as my left, but I walked 1 mile today, 21 days post-op, and I am happy. Remember, I had two of these suckers. The excercises he has you do post op are simple and not very macho, but I believe my following instructions, doing them 2x per day, increasing reps, walking twice per day has help me progress rapidly.

I was scared senseless, and it was a good experience. You want have any pain while at the hospital. While you are there the PT folkes will see 2x per day.

I hope I haven't told you more than you want to know. I will be glad to speak with you by phone if you like. I'm just paying back what people did for me when I was in your position.

Mike
Mike
Bilateral
Dr. Thomas Gross
Left 6/23/08  Right 6/25/08

takilasunrise

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Re: BCBS Coverage?
« Reply #11 on: July 18, 2008, 06:18:05 PM »
Dr. Jeffrey Butler out of St. Luke's in Milwaukee, WI did mine.  I have Anthem BCBS.  I live about 30 minutes south of Milwaukee.  My insurance covered it with no problem (just had to pay my $100.00 co-pay).  I am very happy with my procedure!  I have been pain free and loving it!  Sometimes I forget about the pain I used to experience 7 months ago.  Good luck! 

triathloner

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Re: BCBS Coverage?
« Reply #12 on: July 19, 2008, 04:27:54 AM »
Well fortunately he is in my network.  Do you know how many resurfacings he has done?  I'm probably being over cautious but at 38 I really don't want a thr.  Thanks for your help. 
left biomet Dr. Gross 10-22-08

 

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