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beth1954

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Speaking of insurance companies, they are putting alot of things in jeopardy for me too. I have been getting physical therapy for my neck twice a week. It is much more per visit than I thought. And just about the time I get done with that, I'll be starting PT for my knee. Plus my insurance company would hardly pay anything on the ambulance from my accident in February. I owe the ambulance co. a huge amount of money. They charged $1500 for a 12 mile transport. There are other things that have happened this year that weren't covered either, and I bring in a VERY small salary and have a 79 year old mother that lives with me. We barely get by. I am going to have to stop the PT on my neck, and hope that I can save up some money or work something out with the PT people so that it doesn't literally take food off the table.
I'm feeling really overwhelmed right now. Sorry. I guess I need to find a depression forum right now!
 

loggon

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No you have a forum right here.

What kind of accident? Perhaps another policy or under a different part of your policy it would pay more.

How many visits are you allowed for PT on your insurance plan. Most plans do not offer a lot of PT.

Talk to the folks at your PT they may reduce the price for you.

Question always why something was not paid and why it was not paid as you thought it should have been.

Sometimes it is the way it is coded from the medical provider when sent to the insurance company. You can ask your insurance company if another code would have been better so that you would not have so much out of pocket.

Do you have individual insurance or on a work plan.
 

Jamie

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So, Jo....do you think this might be worth fighting based on what you just posted?

Gringo, I definitely would talk to your surgeon in Texas and let him know what's going on. Sometimes they have things they can do to help. You need to be able to return to him if at all possible.
 

Texas

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Sorry Beth I sure hope it gets better. PT will usually work with you . They did for me for almost the same reason. I lost ins and hubby lost his job. 4 kids they were really great to me...Vent anytime.. Do you have a thread. Gringo becareful with the India thing. I dont know why, something about it. Thats an idea let the Dr know , maybe he can write something for you...Just a good thought she had...
 

Josephine

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Jamie, one could say that if he had one arthritic knee, the odds were highly in favour of his having two! But that's working on common sense and in my experience, insurance companies of any type don't generally work on that too much. I think they've spotted and easy 'out' for wriggling out of it and jumped at the chance. I wouldn't ever give up on it, you never know ...

Beth, you poor sweetheart. That is a terrible situation to be in. I honestly don't know how you folk cope with that kind of stress.

 

beth1954

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I guess one of the best things about this forum is that you can always find someone that has more to deal with than yourself. Whenever I get down about money, stress, etc. I see someone here that is dealing with more. Losing jobs, losing insurance, etc. I don't know WHAT I would do.

After I wrote that message I felt kind of stupid. My problems are small compared to so many.

I already did all the checking about my out of pocket expenses, etc. I even talked to the lady at Human Resources who is really good about dealing with the ins. co. about these kinds of things. Since those two bills in particular were out of network, the ins. co. actually paid more than usual since the ambulance bill was an "emergency" and you don't have a choice of which company takes you to the hospital. I called them myself and they said they will not negotiate. I'm just feeling really overwhelmed lately and now my daughter is worried about losing her job. I don't handle things like this well. I think worse than most people. (Depression, anxiety, mood disorder might have something to do with that.)

I haven't talked to the PT place yet about my bill. They are all so sweet there, that I think they would do what they can.

(Yes, I am on a work ins. program. I work for a city government.)

:cry:

I appreciate you letting me vent on this. I know that things will work out one way or another....just so stressful right now.
 

aussie

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Thinking of you Beth and sending hugs your way.
 

Motherofmany

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Gringo,

Have you talked with your surgeon in Texas yet??? Surely he could be of assistance with the diagnosis to allow the surgery. He is the expert and would be your best bet...me thinks.

Beth,

I have found even when things are out of network if I send a copy of my insurance explanation of benefits they will match benefits. Happened with the anesthesiologists. Still owed some, but only about 40% of what they were originally asking. Worth a try. If they want something, they will work with you. You can always pay $5 a month until it's paid off if they want to be that stinky about it! As long as you are making an effort to pay, they can't do anything about it.

Also talk with you PT and see if there are things you can do at home to help with your progress to save the extra money.
 
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Gringo

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Yeah, I have passed this on to the surgeons office in Houston. And also, I am looking into alternatives. Right now, India is not in first place. I found info on this Hospital Clinica Biblica in San Jose Costa Rica, that is looking pretty good to me. they are $ 3K more than India for the same procedure, but two round trip air fares to India would be $6K coach. two business/first class fares to Costa Rica would be $3K. So the air fare cost alone would cover the difference. With the added bonus of being able to fly comfortably in business class or better and also not having that LOOOOOONG flight back after surgery.

I continue to argue with insurance company. BUT this morning I emailed them and asked if they would settle for paying $ 10K in Costa Rica vs. $ 50K in the US. That outta throw them.

As for other issues...I am not sure how important it is to have the same OS for the other knee. Also, I am not sure if it really makes any difference if I have two different prosthesis brands installed. I mean, does it matter, really? each knee is a unique medical situation in itself. They are not identical in any way, and whoever does the second one really has no info to be gleaned from the first one....

Beth, sorry to hear about your hassles. They make mine look small by comparison. Still, its all on the rocky road to improvement, I hope. Just seems some roads have more potholes than others.
 

Texas

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Hi Beth I hope you are having a better day. My heart does go out to you and your family...
Gringo, no it doesnt make your problems any less. I guess heat people were saying is just becareful going to other countries like that...Down the road if you have a problem you would have to go back..(ehich I hope you dont) .Unless another Dr here could ck you were you are living. I dont think it matters if 2 diff. ones do the knees. Just select a good Dr thats all we want for you. Wow I hope the Ins goes for it, If they think about it it might be cheaper then a law suit..
Beth please post anytime even just to talk join it these people can make you feel wonderful, a laugh here and there....Keep us posted....
 

loggon

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Beth
I don't know what kind of insurance you have but it is through your work so something seems admist. You seem to be billed for way too much. I still wondering why they did not take care of most of the ambulance bill. Emergency should fall in the same as network.
You have no choice and most insurance will pay as in network.

You may want to contact a supervisor at the insurance company and explain what happen. Persistence pays off usually.

Bless your heart, you do have a lot of worries. And we are all here to listen and help out if we can.

Will say a prayer your troubles will soon come to an end.
 

loggon

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Gringo
If you have a friend that is a lawyer you might want them to send a letter to the ins. company a long with a copy of a letter from your doctor and with the explanation you post earlier it is not the same problem.

Dang those prices are hi to fly from where you are. Costa Rica my daughter in law has some relatives there I believe. I am going to see and then if she does, I will ask her to find out about the knee surgery. Not sure if they are still living there though, but will ask.
 
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Gringo

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prices are high because we have to fly north to Miami first, and THEN we pay what you do to get from Miami to Central America. Same on the return. Heck, if I was still current I would just fly myself. But my pilots licenses are all rusty.

you know, one of the things I have found out in all my travels, and now living abroad among a whole lot of people from other countries is that people in the US tend to think that we have the best of everything there, and that the rest of the world is somewhat substandard.

Well, this is partially true, but not totally. The USA does have the best technology that exists anywhere, in most things. But this does not mean that this technology does not exist in other places, too. And in some technologies, the USA is a little blinded to the reality that other countries are passing us by. Look at the automobile industry. Or the motorcycle industry ( sorry England, but you, too.) Look at consumer electronics. Other nations build airplances every bit as good as Boeing or MD. We are not the only nation in space, by a long shot.

I guess what I am saying is that I am finding doctors in other countries who I think might just be as good as docs in the US. There are some in India, who meet the criteria of people posting here that want to see a few thousand TKRs a year.

I have located a doc in Costa Rica that is very, very well thought of by his patients, and I have already had some email exchanges with some of them. Talk about glowing endorsements, of the hospital, the staff, and the results. By Canadians, who have health care covered, but don't feel like waiting years just to get it done in Canada, for example.

I have just been communicating with some people who are familiar with the Hospital Angeles in Tijuana, and here is another center of excellent care. Cost? What will cost $ 50,000 in San Diego will cost $ `13,000 just a half hour's drive south of there. Modern, state of the art. And the patient private rooms blow US hospitals away!

SO, I guess I am not nearly as nervous about going elsewhere, out of the USA, for medical help, if I have to. Heck, I went elsewhere for my life, and have not regretted it for a second!

Costa Rica is still in first place for convenience, cost, and happy faces.
 

Motherofmany

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Glad to hear you are finding some other options that will work for you and are trustworthy. That's the most important thing I think is to trust your surgeon and get good care. Sure hope you are able to work this out with your insurance company and it goes well for you.
 

Josephine

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It makes no difference at all, Gringo. People often have two different knees and hips as well, for that matter. As I've often said before, it's pretty much of a muchness in the end!
 

Judles

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Ummmmm.....please be careful of Mexico, Gringo! Take your follow ups into consideration! There are a lot of what ifs to consider!!!
 

Jamie

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Gringo, my concern was just that you are able to find a good surgeon wherever you go. You know the doc in Houston is good, but if he's not a possiblity then you just have to do more research.

Interesting about Costa Rica.....I would not have thought of that country. Can you post some links to what you're looking at?

I think you are right to continue to work with your insurance company. And to enlist your Houston doctor's help. I have seen many cases where people are successful if they just keep pushing.

Beth, I agree that you need to continue to talk with the therapists and the ambulance company about reducing their fees. Then if that doesn't work, the suggestion to pay something each month works. Our daughter, who works in day care and had no insurance at all, has done that....pay $10 a month until the invoice is settled. Since medical providers don't charge interest, the balance does not incur a finance charge. So you actually can get it paid off....just takes a while.
 

loggon

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Gringo
You are so right. You are doing the research and that is what is important. Costa Rica is a beautiful place and it has its mix of modern and old.

Ask your old OS about a surgeon there. He should know. He understands your insurance problem.

You are on the right track but continue to fight the insurance company, they are doing you wrong and I am speaking with over 40 years of experience in the insurance business. Teaching insurance, selling and process insurance from the working at large companies to having my own agency for over 25 years. You are being taken
by yours.

Good luck. Keep us informed for sure. You will do good because you had amazing results/recovery with your first one.
 
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Gringo,
What it all boils down to is you have to do what you want to do!!
U.S. or Costa Rica. You are the one who must feel that it will be
ok. Yes I am sure we feel we have good medical services in the
states. I am a service brat remember. So I know our medical is
pretty darn good. But that does not mean there our not good
Doctor's else where. But it is not just the Doctor Gringo you
have to feel comfortable with!!!! "Just sayin" Ok? You know
that you are family here and now you have more Sister's then
you ever wanted!!! But you are stuck with us and we will be
right there with your Misses worrying about you!!! And by the
way what does the Misses have to say??? Is she apart of
all the plans???
 

Judles

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Yes! How is La Gringa feeling? Is her back any better? Send our regards!!! :)
 
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