THR FINALLY!!! Cynthia777's Recovery Journey
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Cynthia777
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Arlene56
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@Cynthia777 Wow. That's a lot of money. We have Blue Cross Blue Shield of IL. Our out of pocket is only $300. Our outpatient PT is expensive at $40 per visit. I haven't received the statement of the surgery yet. If will be interesting to see an itemized statement. It's strange how policies differ even within the same insurance company.
I have been fighting with our prescription company for 3 months about medication for our son. His medicine has always been covered up until this year. Now since it is a "NonPreferred" he has to pay $120 a month compared to $40 last year. His Dr has submitted 2 letters of necessity for this medication. The prescription company wrote back suggesting other medication, which by the way, he has tried but to no avail. I don't think I can fight this. But it irritates me to no end that the insurance/prescription companies dictate what is best for the patient.
So we are helping him with the cost. He is 23 and still on our plan. Oops - sorry for the rant.
I have been fighting with our prescription company for 3 months about medication for our son. His medicine has always been covered up until this year. Now since it is a "NonPreferred" he has to pay $120 a month compared to $40 last year. His Dr has submitted 2 letters of necessity for this medication. The prescription company wrote back suggesting other medication, which by the way, he has tried but to no avail. I don't think I can fight this. But it irritates me to no end that the insurance/prescription companies dictate what is best for the patient.
So we are helping him with the cost. He is 23 and still on our plan. Oops - sorry for the rant.
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Cynthia777
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@Arlene56
That's crazy! Although I have no deductible the lowest out of pocket in California is $4,000 annually ($7,000 out of network providers). I pay $20 for a doctor visit, but $40 for any specialist and PT is $20 a visit. However, I pay $864 a month just for me. I find it pretty outrageous.
That's crazy! Although I have no deductible the lowest out of pocket in California is $4,000 annually ($7,000 out of network providers). I pay $20 for a doctor visit, but $40 for any specialist and PT is $20 a visit. However, I pay $864 a month just for me. I find it pretty outrageous.
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Cynthia777
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Cynthia777
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DeepBreath
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@Cynthia777, Bwahahahahahaha! 
That is too darned cute! Can you imagine? "Doc, I feel like...I don't know...like I have corn dogs in my hips or something!"
That is too darned cute! Can you imagine? "Doc, I feel like...I don't know...like I have corn dogs in my hips or something!" SweetPea69
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@Cynthia777
That's a hoot!!! Thanks for the good laugh!
That's a hoot!!! Thanks for the good laugh!
Kim22
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@Cynthia777 Congratulations on a great recovery with your first hip.You have done really well I am well impressed that you can actually sit Indian style I can't imagine being able to do that ever ! I hope your recovery from your second one is just as good and won't it be fantastic for you to have legs the same length again and to be a bit taller as an added bonus.I remember how much research you did in choosing your surgeon and it has paid off.Have you been in your pool since your surgery ? Gosh your hospital bill seems a tad steep and I hope you get it sorted out soon.I am so grateful for our NHS as you don't get a bill but of course you do pay for health care up front in taxation so there are drawbacks to both systems.Sending you lots of luck for the 28th April.
Squirrellymom
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Wowzer, I'm glad I got to see a peek into what insurance companies are being charged and what they are
paying. I just received my statement for my RTHR from Medicare yesterday and I was in a panic because my LTHR is just over a week away in the same hospital, with the same surgeon and I was skeered that my OS and the hospital would call and tell me that they just didn't get enough from my Hip #1 and they were going to have to cancel #2.
The total billed to Medicare (now don't you dare mess with my "earned" medical benefit) for the one night (24 hrs) in hospital, surgeon, operating room, anesthesiologist, PT (4 sessions) prosthesis, everything ... was $56,894. and Medicare paid $10,979 and my Medicare Plan "B" policy (for which we pay $240 mo.) picked up $1,288. and that is it. Done. Because of my supplemental Medicare "B", I do not have any out-of-pocket expenses. Provider billed $56,894. and actually received an "allowed amount" of $12,267. So @Cynthia777 hang in there until you see what the actual negotiated amount will be.
I am fascinated by all of this discussion as I lobbied long and hard politically for "single payer" medical for all before the ACA compromises gave us weakened, piecemeal health insurance with only the insurance companies benefiting. Blue Cross of Tennessee had a 36.3 percent average rate increase in premiums for 2016. Insurance companies can't make the big profits with ACA because the new health insurance laws mandate covering pre-existing, yearly check-ups, children under 26 allowed on parent's policies and so much more. Private insurance company profits and pharmaceutical profits all make national, single payer insurance a necessity. I wouldn't want to deny anyone a new hip or knee or any other medical service and medical bankruptcies are purely evil. The high cost of health care in the United States, the most expensive place in the world to get sick. Oh my, I can really step up on that political soapbox easily now with my good hip.
--julie
paying. I just received my statement for my RTHR from Medicare yesterday and I was in a panic because my LTHR is just over a week away in the same hospital, with the same surgeon and I was skeered that my OS and the hospital would call and tell me that they just didn't get enough from my Hip #1 and they were going to have to cancel #2.
The total billed to Medicare (now don't you dare mess with my "earned" medical benefit) for the one night (24 hrs) in hospital, surgeon, operating room, anesthesiologist, PT (4 sessions) prosthesis, everything ... was $56,894. and Medicare paid $10,979 and my Medicare Plan "B" policy (for which we pay $240 mo.) picked up $1,288. and that is it. Done. Because of my supplemental Medicare "B", I do not have any out-of-pocket expenses. Provider billed $56,894. and actually received an "allowed amount" of $12,267. So @Cynthia777 hang in there until you see what the actual negotiated amount will be.
I am fascinated by all of this discussion as I lobbied long and hard politically for "single payer" medical for all before the ACA compromises gave us weakened, piecemeal health insurance with only the insurance companies benefiting. Blue Cross of Tennessee had a 36.3 percent average rate increase in premiums for 2016. Insurance companies can't make the big profits with ACA because the new health insurance laws mandate covering pre-existing, yearly check-ups, children under 26 allowed on parent's policies and so much more. Private insurance company profits and pharmaceutical profits all make national, single payer insurance a necessity. I wouldn't want to deny anyone a new hip or knee or any other medical service and medical bankruptcies are purely evil. The high cost of health care in the United States, the most expensive place in the world to get sick. Oh my, I can really step up on that political soapbox easily now with my good hip.
--julie
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Cynthia777
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Thanks @Kim22! Now you had to go and ask about the pool! No, haven't even put my toe in! 
@Squirrellymom
We in California also have a state run plan. My premium was $562 at the end of 2014 and for the same exact plan is now $864. An increase of just under 55%! So ridiculous! Of course, I should be grateful that BSCA is paying for most of my charges for the THR's! I'm sure the approved amount will be FAR less than the hospital is billing.
@Squirrellymom
We in California also have a state run plan. My premium was $562 at the end of 2014 and for the same exact plan is now $864. An increase of just under 55%! So ridiculous! Of course, I should be grateful that BSCA is paying for most of my charges for the THR's! I'm sure the approved amount will be FAR less than the hospital is billing.
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Cynthia777
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@Squirrellymom
You must really be enjoying this years primaries, I know am (over half of my day is devoted to politics on tv these days)! Quite the race!!!!
You must really be enjoying this years primaries, I know am (over half of my day is devoted to politics on tv these days)! Quite the race!!!!
CatLady1
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LOL! Julie, you are too funny! I'll have to go look at my bill and see how it came out. I know I payed a co-pay of $1,800 while getting ready for surgery. Nothing like telling someone who just took off all their clothes and put on a hospital gown that now you need to pay your bill. Or what? You'll take the gown and tell me to leave?? (thank goodness I had brought my wallet in with me, ha ha). One thing that struck me - was when the surgeon's office told me that pre-surgery appointments, surgery and all the appointments afterwards for up to 90 days were covered in the one surgery cost. My next appointment in June, at 6 months will be a $45 co-pay. Thank goodness there wasn't PT to add to the cost: each PT session would have cost me $25 (assuming I would have gone to a 3rd party PT shop).
Without knowing how much additional cost I'd rack up with surgery, I scheduled my THR first thing in January, in the event I'd reach my deductible and have more medical this year. So far it doesn't look that way.
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Cynthia777
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Arlene56
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@CatLady1
A week or so before my surgery, the hospital called to confirm our insurance benefits. She told us that we needed to bring our checkbook to pay our copay of $300. She indicated that it is required to pay the copay at time of admittance. It just amazes me how different a few years make in our health care system.
In one of my posts, I was sharing how I have had to fight to get our sons medication covered. After 3 months I receive an email that CVS would override the plan so our son can get the proper medicine he needs to function. So later in the day our son goes to CVS to get his prescription. CVS said Brand is not covered only generic. So once again, I had to contact our representative to ask what's up. They don't even do what they say they are going to do. It's so frustrating. I usually don't loose my cool but I am ready to give someone an ear full. You know the saying "watch out for mamma bear."
Anyway, hope you have a wonderful weekend!
A week or so before my surgery, the hospital called to confirm our insurance benefits. She told us that we needed to bring our checkbook to pay our copay of $300. She indicated that it is required to pay the copay at time of admittance. It just amazes me how different a few years make in our health care system.
In one of my posts, I was sharing how I have had to fight to get our sons medication covered. After 3 months I receive an email that CVS would override the plan so our son can get the proper medicine he needs to function. So later in the day our son goes to CVS to get his prescription. CVS said Brand is not covered only generic. So once again, I had to contact our representative to ask what's up. They don't even do what they say they are going to do. It's so frustrating. I usually don't loose my cool but I am ready to give someone an ear full. You know the saying "watch out for mamma bear."
Anyway, hope you have a wonderful weekend!
dandy_candi
senior
It's so interesting to see the difference in medical costs between countries. I have private health here in Aus although I wouldn't have had to have it to get my hips done, there is public health that would have covered getting THR but I preferred to have choice of surgeon and hospital as well as time lines.
I pay $140 a month for the highest level health insurance with my preferred company that includes hip replacement but not Obstetrics and reproductive services (I don't want kids). My surgeon charges $1000 per surgery out of pocket, plus anaesthetist fees which could be between $200 and $1000, per surgery. My once off excess for my health insurance is $250 for the year, so all up looking at $4,250 at the top end. The cost of a hip replacement is Aus is said to be approx $25,000.
Yay for a second date @Cynthia777!!!! Countdown is on!
Candice, 28 yo. Rheumatoid Arthritis. Australia. Sequential unilateral THR June 1st 2016 and July 13th 2016
I pay $140 a month for the highest level health insurance with my preferred company that includes hip replacement but not Obstetrics and reproductive services (I don't want kids). My surgeon charges $1000 per surgery out of pocket, plus anaesthetist fees which could be between $200 and $1000, per surgery. My once off excess for my health insurance is $250 for the year, so all up looking at $4,250 at the top end. The cost of a hip replacement is Aus is said to be approx $25,000.
Yay for a second date @Cynthia777!!!! Countdown is on!
Candice, 28 yo. Rheumatoid Arthritis. Australia. Sequential unilateral THR June 1st 2016 and July 13th 2016
Zelda
graduate
I was going to ask about the pool too, @Cynthia777 . I don't want to swim but I quite fancy just floating, weightless in a pool just now and I wondered if you using yours for anything other than laps!
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