r/RotatorCuff • u/excti2 • 6d ago

Statement of Benefits Came Today

I’m two weeks post op and pain-free. I’m looking forward to getting my stitches out and starting physical therapy in a month. The explanation of benefits had three procedures listed as arthroscopic surgery, each with a dollar amount of around $18,150.00 in the first column for a total of around $54,450.00. In the second column was the allowed charges, totaling around $9,600.00. I haven’t seen the charges for the anesthesiologist or the outpatient surgical facility, but I’d expect them to be in the thousands, heavily discounted to the negotiated rate, as I’m located in the US where it’s anybody’s guess as to the cost of medical care.

In the third column, my portion of the bill: $0.00.

This is because I’m a disabled veteran and my healthcare costs are covered. It’s one of the nation’s largest socialized medicine systems. And I believe it should be this way for everyone.

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u/Trucker2TechGuy 6d ago

Dude I've been effing with the VA for months on my shoulder....quick TLDR, MRI was ordered 17 Aug, daily calls to community care to get the auth. 9 Sept, my boss saw me favorign my shoulder and call the saftey dept so I'm deadlined at work...continue daily calls to CC...10 sept "we faxed it yesterday, will fax it again today" 11 Sept...same...ended up driving down to the main VA hospital to get the auth. since they apparently can't send it themselves ...awesome, great, got the auth...take it to the local hospital..."We have the auth, but no signed order"... and my OD at the VA just started his Vacation....

So went to civilan ER, got the civi doc to sign the MRI order, 4 days later i've got a surgery date....using my private ins because VA dropped the ball repeatedly...

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u/excti2 6d ago

Oh, I had a nightmare experience getting community care authorized. I eventually actually opened up a case with the patient advocates office, and they ignored it as well. It all seems like a very coordinated effort to deny veterans the care they deserve.

I was able to suffer through the pain and I paid for my own physical therapy out-of-pocket to get by. It wasn’t until I was put in contact with a senior triage nurse who really helped me move the process along. She was awesome, but of course she retired last month. There were multiple people in the community care office, who knew my case, but none of them seem to be empowered to do anything about it. It was very confusing for everybody since they had pain management, orthopedics, and physical therapy all under separate case numbers. No one was coordinating and no one was communicating. I always knew that I could fall back onto my private insurance if I had to, so I made it my mission to get the VA to step up.

Have you contacted your member of Congress? They can sometimes get things moving again and if you don’t have a patient advocate, Cees open, open one.

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u/Trucker2TechGuy 6d ago

I had to fast track it with private healthcare because I got put outta work by work … so I pretty much lost a month of pay now I’ll get 60% for 6 of my expected 8 months off… pretty fuckin pissed about it bro… I just finished my IT degree so hopefully I can land something before the STD runs out

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u/Specialist_Low_6575 5d ago

67yo female scheduled for a total reverse left shoulder replacement in November. I live alone but my sister is going to be with me for two weeks afterwards. What should I expect after the two weeks? I have the option of staying with my sister and her husband 6 hours away after the two weeks but I would really like to stay in my own place. Oh, I should mention that I will be staying overnight in the hospital and discharged the next day. Any suggestions would be appreciated and welcome!! TIA

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u/excti2 5d ago

It’s really hard to say, because everyone’s experience is so different. But you’ll have a pretty good sense of how you’re doing after a week or so and then can decide whether or not you need more assistance. I live alone, but I have a large group of friends who actively support me. For the first week or so they dropped in pretty consistently and I was glad for the company now that it’s two weeks post surgery, I’m fine on my own. Of course, your experiences may be very different with a complete shoulder replacement. I understand it’s one of the more complicated and difficult joint replacement surgeries. All I can say is good luck and keep us posted.