Blue Cross/Blue Shield and Total Hip Replacement : LUSENET : About Joints : One Thread

I am 31 years old and am need of total hip replacement surgery to AVN disease. The right leg is completely unable to support me anymore, and has actually shortened by about 1.75 inches. I am totally scared of the surgery, and how my life will be after the surgery, whether I will be able to live life again. Right now im totally bedridden, and am waiting for a blood test to see if I can handle the surgery. I also have an ailing liver which the surgeon is worried on my ability to take the surgery. Nevertheless he is going to do the surgery, but what comes next is what REALLY scares me. HOW TO PAY FOR IT. Right now, I am on disability from my job at Texas A&M university and recieve Blue Cross / blue shield insurance thru the university. I know that THR surgery is on the list of approved surgeries, but have been also told they (Blue Cross/Blue Shield) could deny the surgery for the hell of it. I hear alot of sucess stories of Hip replacment, but never hear how it was paid for. Does it work on some kind of payment plan for surgery? Or does anyone else out there with Blue Cross / Blue Shield ever had this kind of surgery done? I cant believe that I can be denied surgery because of lack of payment means, even if I have insurance. Does anyone have ANY insite on how payment works? and what does it cost (ballpark figure) for the surgery and or subsequent therapy?

-- Daniel Rydzewski (, July 25, 2004


Blue Cross/Blue Shield is different in every state, but I doubt very much they would deny the surgery. The first thing to do is have the doctor's office contact Blue Cross and get you pre-certified. That will tell you if they will pay and what they will pay. Also make sure your hospital accepts Blue Cross and that your doctor utilizes assistants, radiologists, etc. that also accept Blue Cross. (These are additional costs besides your main surgeon.) Check your policy for your deductible and your doctor's office for a payment plan (in case your doctor does not accept the allowed amount.) Get your mind relieved of this terrifying financial burden first, then concentrate on the outcome of the surgery. Also, be sure you have a VERY GOOD surgeon!! That's more important than anything. I'm sure you will be hearing from others. Good luck! Jan

-- J Bear (, July 25, 2004.

Hi there,

I had a THR in October of 2000 and had BC/BS of Arkansas. BC/BS paid for it all minus what I knew I had to pay according to my policy. The Dr.'s office should call BC/BS before you have surgery to verify that you have benefits and get a confirmation # for lack of being able to think what it's called. When you go in the hospital to pre-admit they will tell you what their payment options are and you just sign up for one. My hospital and I'm sure many others have a payment plan. Some are with interest and some are not. You can pay the balance by Credit Card or sometimes in 4 or 5 payments with no interest, etc. Just call the hospital and ask them if you can't wait to know. You can even call BC/BS and get precertified yourself or check to make sure the Dr. did it. Even it the Dr.'s office calls it's always wise for you to call and verify. Believe you me the Dr.'s office will not proceed until they know what is going on. This is really no big deal. If it's in your policy they have to pay for it. I even had MAJOR complications for years after and BC/BS paid 100% for home health care nurses and supplies to dress my wound that is still not healed (No, I'm not diabetic). They gave me what is called a Case Manager and she had the power to pay things and make decisions on her own. In my case it was cheaper to pay for home health care then to be in the hospital for months on end so they paid the lesser of 2 evils and it was a heck of a lot better for me. I have had really good luck with all insurance companies that I have dealt with on this issue. Good Luck and I hope you get out of pain. By the way. What symptoms are you having? Please don't be afraid, just trust in God to do the right thing and you'll be fine:-)

I actually fell because of my hip a couple of years ago and injured the knee on the same side as the THR and because of walking kooky I guess (I still walk with a cane because of the knee now and the severe groin pain that comes through the pain medicine when I walk too long, was why I had surgery in the first place), and now have to have a knee replacement but cannot until the wound heals.

I'm sure yours will go find as a great percentage of them do. Are they going to make up for the shortening in your leg during surgery? I have a tendency to ramble so please forgive me. Get up every day and do your best and God will do the rest.

Best Wishes,

-- Sue Shields (, July 26, 2004.

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