Well it seems no matter how you try you just can't win!
I received a call back from Dr. Kelly's office quite quickly after my email. This it seems was not a good sign. I was told that even though my insurance said I have a DME benefit, that once they received the information the claims would still be denied, because you don't need a CPM for hip surgery and you can use ice instead of the game ready. Basically they go for the cheapest way out to not pay. Bugger! Plus, something I do not recall being mentioned earlier, I was told that HSS has a "very strict policy about DME's and where they are supplied from". Kickbacks anyone? Either way, I'm completely buggered and will have to pay out of pocket for both. ARGH!
On a different note, I am searching for a certain type of crutches that seem to be the best for me with my crap hands and shoulders. They are called Platform crutches, similar to forearm but not quite the same. Of course they're expensive and hopefully I will be able to get a hold of these if the PT approves. My main concern is not to destroy my hands whilst trying to save my hip.
Ain't life grand?
Well, the good news is that the surgery was approved, so I guess that is one less fight for me!
07 August, 2007
insurance insanity
I received the various papers from Dr. Kelly's office this weekend and did not really feel like dealing with them until today.
I guess if you can't plan a holiday, then planning surgery is an option!
I rang up the anesthesiologists office first to see if they are covered. They do not participate in any plans. Ok, fine, the dr's office warned me. However the woman I spoke to in their billing department was very helpful. She said to ring up Oxford and tell them that the Dr and the hospital both participate in the plan, and ask to what extent the anesthesiologist would be covered. Yippee! Ms. Crystal said that since both are covered then the anesthesiologist would be covered as "in network" status. That was definitely one thing off my shoulders.
The onto what is know as "Durable Equipment". I never heard this term before, but it seems the machines the dr wants you to use after surgery fall under this title. The dr's office did tell me that even though the insurance will say that they cover the CPM, when they see the diagnosis for hip they will not, as the machine was made for knee issues. A bit daft if you ask me b/c there is no CPM specifically for hips, but that's insurance co's for you! But it can't hurt to try to get some coverage! I asked Ms. Crystal at Oxford about this and she gave me a list of the nearest Ortho places that they work with for DE's. I rang up one and they referred me to their LI office, saying that all equipment can be sent into the city. They seemed most helpful when I rang, took down all of my information, and asked that the dr's office fax over a prescription for what I need. I've just sent an email to the dr's office requesting that prescription be faxed over (lets see how long this takes). If there is any way I can get some of this covered I'm sure as heck going to try! I have a feeling all of the incidentals are going to add up!
I guess if you can't plan a holiday, then planning surgery is an option!
I rang up the anesthesiologists office first to see if they are covered. They do not participate in any plans. Ok, fine, the dr's office warned me. However the woman I spoke to in their billing department was very helpful. She said to ring up Oxford and tell them that the Dr and the hospital both participate in the plan, and ask to what extent the anesthesiologist would be covered. Yippee! Ms. Crystal said that since both are covered then the anesthesiologist would be covered as "in network" status. That was definitely one thing off my shoulders.
The onto what is know as "Durable Equipment". I never heard this term before, but it seems the machines the dr wants you to use after surgery fall under this title. The dr's office did tell me that even though the insurance will say that they cover the CPM, when they see the diagnosis for hip they will not, as the machine was made for knee issues. A bit daft if you ask me b/c there is no CPM specifically for hips, but that's insurance co's for you! But it can't hurt to try to get some coverage! I asked Ms. Crystal at Oxford about this and she gave me a list of the nearest Ortho places that they work with for DE's. I rang up one and they referred me to their LI office, saying that all equipment can be sent into the city. They seemed most helpful when I rang, took down all of my information, and asked that the dr's office fax over a prescription for what I need. I've just sent an email to the dr's office requesting that prescription be faxed over (lets see how long this takes). If there is any way I can get some of this covered I'm sure as heck going to try! I have a feeling all of the incidentals are going to add up!
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