Arthritis - How To Avoid Pocketbook Shock

In these days of confusing and rapidly changing health insurance plans, you can't overdo the questions about what is and what is not covered.

Ask the hospital:

Who are all the separate health care professionals I will receive a bill from? Often the surgeon, anesthesiologist, and physical therapist, for example, send a bill separate from the hospital's.

And ask your health insurance representative:

Is this hospital a preferred or approved hospital? Which of my doctors are preferred? While your surgeon might be "preferred," your anesthesiologist might not be, which can make a big difference in how much money you have to shell out. It's best to know ahead of time.

How long a hospital stay is allowed? You don't want to be arguing this while you're in the hospital and perhaps feeling bad. Get this spelled out ahead of time. Ask exactly what's required if your doctor feels you need more recovery time in the hospital than your health plan specifies.

Precisely what after-surgery care is paid for? Your doctor may want you to work with a physical therapist, an occupational therapist, or a nutritionist. Find out if these are covered, and get names of preferred or approved ones.

Are crutches, splints, or a walker paid for? If so, how do you get the claim forms? Do you need to purchase or rent these aids from a specific place?

Is home health care paid for? If not, and your doctor recommends it, some communities offer home care for payment on a sliding scale, which means it's based on your ability to pay. You may need only a recommendation from your doctor.

Ask your company benefits administrator:

Do I get disability pay from work, and how much is it and how long will it last?

What To Expect After Surgery

Right after a joint replacement, you're not going to feel ready for your tango lesson. The joint itself shouldn't pain you, but muscles moved around during the surgery will hurt. Depending on the nature of your surgery and your immediate postoperative condition, your doctor may provide oral painkillers ranging from Tylenol to codeine derivatives. On the first day after therapy, you may start passive exercises, with a therapist gently moving your limb. This will help strengthen the muscles around the new joint. On the second day, you'll probably be allowed to walk around, using a walker and later crutches. You'll feel pretty doddery, but hang in there; it gets better.

Though you'll be able to get around, take it easy for a while. Your joint won't be 100 percent healed for some time. So it's crucial to follow your doctor's directions carefully (and to ask questions if you're unsure of any specifics). With a hip replacement, you'll likely be 80 percent recovered after four weeks and completely recovered in six months. If your knee was replaced, it will take six weeks to reach that 80 percent mark, six months to be 90 percent recovered, and a full year before you're completely healed.

One important partner in your recovery will be a physical therapist, who will design a specific exercise program for you. The physical therapist will discuss the treatment plan with you and write out the entire program, including diagrams of how to do each exercise. She will also discuss how long you can expect your recovery to take and set both long-and short-term goals you should aim for.

You may be asked to do continuous passive motion (CPM). For a recovering knee, for example, you would sit while a device at the foot of your bed bends and straightens your leg continuously, several hours a day, while you watch Oprah or read. Gradually, the movement will increase the range of motion in your joint. CPM, in combination with regular physical therapy, can help your joint recover faster and reduce swelling after the operation. Also, the cost of a CPM device is less than having a physical therapist do all of the work with you.

lt's normal to grow impatient during the recovery period. It's easy to forget how bad things were before the surgery and why you had it in the first place. But the ultimate success of your new joint and your recovery depends partly on your commitment to take good care of yourself and your joint. A postsurgical joint will never be just like the original before the arthritis, but an operation can allow you to resume a more active and nearly pain-free life. Depending on your situation, you may have to walk briskly instead of run marathons or play volleyball instead of tackle football, but your life can still be vigorous and full.

In these days of confusing and rapidly changing health insurance plans, you can't overdo the questions about what is and what is not covered.

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