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[T_bone]

Hello to all of you,

I'll start off by expressing gratitude for the existence of this forum. It's been a great place to come for answers and information on the Limb-lengthening experience in general. Thanks for that. I'm starting this journal midway through the pre-surgery process with Dr. Rozbruch, hopefully to answer some questions for others as well as receive clarification on some questions that I still have. I'll try to balance between compressing this post down to a quickly readable level and being as clear and concise about my experience thus far. Should anyone have any questions feel free to message me. I will try to be on the forum at least once a day to check in and answer any questions. 

A little bit about where I'm at:

I had my initial consultation with Dr. Rozbruch and his assistant a few months ago, I thought it went very well and found them to be very attentive, professional, and answered my questions to the best of their ability. They told me I was an ideal candidate for the surgery. I am 5'5, 31 years old. The next day I scheduled an appointment with Dr. Westrich for the psych evaluation. The psych evaluation happened 1 week after that and I received a notification that I had been cleared for surgery the following week.

I then called to schedule my surgery for the end of March, mainly because of work reasons, that is the best time for me to take a hiatus and focus on recovery. I was told I would have to wait until early January to initiate the pre-authorization process. Now, I understand that the initial 30k fee for Dr. Rozbruch's services are required upfront. That's fine. But, I also have health insurance, and from the reading I've done on this forum there seems to be a group of Limb-Lengtheners who had the surgery done and then received the bill from HSS afterwards, and then there is another group of Limb-Lengtheners who were required to pay everything, both Rozbruch's fee and the HSS fee, all before the surgery. What I'm trying to figure out is what determines which group you fall into. Because that is a make-or-break factor for me. I have a large amount of savings saved up, and paying Rozbruch's 30k fee is not a problem, and even if the HSS bill is 90K I can pay it, so long as I am billed afterwards and work out a payment plan with HSS. I'm fairly certain they offer that option as they did with the remainder of the bill for the X-rays during the initial consultation after my insurance had covered roughly 60% of it. But if the entire 120k+ fee is required all at once that will be just slightly too high of a financial hit to me, and I will have to look elsewhere (probably Dr. Giotikas in Greece) for the operation. I live in NYC so having to go elsewhere would be a major inconvenience.
   
   So does anyone have any idea what decides whether you receive the bill afterwards or have to pay upfront? Is it completely dependent on your health insurance? HSS is in-network for me. Is it based upon credit-score? I have a very good credit score. Is it all just luck of the draw? Or dependent on timing? At this point I'm just grasping for any info I can that can help clarify the uncertainty. If there is someone out there who knows about any action I could take to resolve this it would be greatly appreciated.

[tiggy]

T-bone,
Call Rs office and ask them for the number of whoever handles patient payment processing at HSS. No one here will give you a sure answer except for HSS. Just ask that person the same question you are asking here, mainly if insurance rejects your claim can you work out a payment plan with HSS as to avoid paying the entire fee upfront (which you cannot handle all at once). I'm quite certain they will work out something with you but the question is how much - would they ask you for half upfront and half right after? No one here can tell you. You need to be sure Rs office understands your position on the issue so that they can direct you to the correct person at HSS. This has nothing to do with your credit score or luck. HSS has its own procedures and what they are allowed to do and not to do in terms of flexibility for receiving payment owed to them. It's as simple as that. Good luck and keep us updated. Hope this helps.

[T_bone]

Tiggy that is very helpful, thank you man. I will do exactly that when things start opening back up after the holidays. I hope I'll be able to work something out with them and I will keep you posted. Happy holidays

[T_bone]

I have news regarding my experience with Dr. Rozbruch in NYC and how my insurance will work. Hopefully this will help those out there who have the same questions.

To my pleasant surprise (although I was kind of expecting this) my surgery has been "approved for 1 overnight stay concurrent upon review". All I know so far is that this means I will only need to pay Rozbruch's fee of 30K, before having the surgery. Then the hospital bill (anywhere between 80-100k from what I'm told) will be sent to my insurance. I have no idea whether my insurance will cover anything at all. They may receive the bill and decide to cover none of it. Are there any experienced limb lengtheners out there who have experienced the same thing? Anyone out there who has some idea if this is a positive indicator that insurance will cover a portion of the hospital bill? If so, I would be eternally grateful to hear your experience.

[sweng]

(first ever post here)

Hi T_bone, being from the Boston area, it seems like Dr. Rozbruch is the best option for me, too.  I'm now considering what the costs would be given my insurance (BCBS MA HMO, but will be changing it to PPO Blue during open enrollment in October).  I'd love to hear what else you may have learned about insurance and potentially how much of the hospital/surgery bill they would cover.  Thanks!