Sunday, March 27, 2011

Who says Depuy won’t reimburse for reasonable medical expenses?

There seem to be lots of criticism (filed by lawyers not patients) discussing what Depuy will and will not reimburse and what exactly has to be signed in order to obtain that reimbursement. First I can tell you as a patient, Depuy and Broadspire, their clam’s agent, have been nothing but helpful and responsive to my submissions of medical claims.  In fact, Broadspire has reimbursed me within a week of the first set of claims I sent to them. That is for direct out of pocket expense incurred by me, they provide rapid reimbursement.  They reimburse considerably faster than Blue Cross does I can surely tell you that!
Second, just as in any medical reimbursement situation, Broadspire will insist on one thing prior to reimbursement: some type of proof that you have the Depuy hip implant.  I find that request reasonable and necessary.  I don’t know of any company that will reimburse you for issues with a product if they don’t have proof that you have the product.  Makes complete sense to me. 
Third, you don’t have to sign away anything in order to get reimbursed.  You do have to provide proof that you have the depuy hip implant and you can do that by just sending in the OR (operating room) report.  That report is a summary of what was done during the surgery and the report contains the name of the implant that the surgeon used.  Your other option is to have the orthopedic surgeon release the information by signing a release form with your physcians.  I don’t care for that option because I want my physicians to come back and get my permission any time they are requested to release medical records on my behalf.
If you have had any other experiences with the Depuy claims process, please let me know. 
The only thing I find  to be annoying is the manner in which Blue Cross handles the routine submission of the Depuy claims.  The process as I understand it, is that your insurance company (in this case my insurance company is Blue Cross) is suppose to pay the claim and subrogate to Depuy.  In theory this sounds great however, Blue cross has no procedure in place to identify which incoming claims are related to Depuy so they pay everything and then send me a summary of what they paid and  what I am responsible for paying.  I then receive a bill from the provider.   When I call Blue Cross to notify them that the expenses are all to be subrogated to Depuy, I wait on the phone for 10 minutes each time until the customer service rep du jour reads my records to then confirm they have a note in my policy to submit the claims to Depuy.  It is a very, very inefficient process.
In January for example, I had 3 radiology appointments, 6 lab tests and 3-4 physician appointments all related to Depuy. Given I have not reached the deductibles; I am responsible for the payments. Now I will be taking a different tact which is to just send the invoices to Depuy myself in those cases rather than going back to the insurance company.  It’s faster than going back to the insurance company and then waiting for them to subrogate to Depuy. 
If the insurance company has in fact made the reimbursement though, you have to go back through them.

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