RESOLUTION to My Post Entitled "Clavell's Office Fuck Up on Insurance Pre Auth, Any Ideas?" PLEASE READ

[Midwest Guy 333]

A few days ago, I posted a new topic about an insurance denial for my surgery WELL after the surgery took place. I am detailing a resolution to that issue here. I wanted to make it into a new topic so no one would miss it rather than having it buried on down the line of responses in the original post.

Late yesterday afternoon, Dr. Clavell personally called me to explain what had happened with my pre auth and took full responsibility for the mix up. What an integrity filled man! He had seen my original post and wanted to reassure me that I would not be responsible for any hospital bills, which in my case were indeed $366,000. Whew! Earlier yesterday, I had called my insurance rep, I had met with an attorney, and I was trying to figure out a plan of action to survive this problem.

Dr. Clavell explained to me that UHC had sent his office a letter stating that since he was in the top 97% of their preferred surgeons, he no longer would need to obtain pre authorizations for these surgeries. What they didn't make clear was that it was only for one specific type of policy. His office did not obtain pre auths for my surgery or for several others until they discovered the "fine print" from the insurance company. Dr. Clavell had refunded in April, the fee I paid him prior to surgery, effectively performing my surgery for free. Unfortunately, he ended up doing that with several other surgeries that fell into the same time frame before the clarification was made on policies still needing pre auth. It's truly unbelievable to me that a medical provider would EVER take responsibility and/or waive their fee, but that is what this man did. Wow. Amazing. He also stated that if I did get bills from the hospital I should contact him directly and he would take care of those charges. I was so relieved that I was shaking by the time the 17 minute call ended.

It's infuriating that an insurance company would pay for this surgery if a pre authorization was obtained prior to the surgery, but wouldn't pay for it because of a procedural mis-step, but my ire for insurance companies, especially UHC is an entirely different and substantial lambast for another place and time. Dr. Clavell did tell me he is planning to create a video detailing surgeon and hospital charges and practices which I think will be very educational, so watch for that.

Here's the thing that was making me feel almost as bad as the huge financial hit I faced: I was thinking how much I liked Dr. Clavell, how skilled he is and how my surgery went perfectly and my implant is perfect and that after how messy this insurance piece was likely to get, he probably wouldn't keep me as a patient. Selfish thoughts perhaps, but this is the first surgery I've ever had in my life and it was an incredibly huge deal for me. I had researched surgeons for over a year. I watched Dr. Clavell's videos as well as several other surgeons videos, and I knew especially after my initial consultation with him (I scrapped my plans to consult with the other two I was considering) that I wanted Dr. Clavell to be my implant surgeon. I love my implant and if anything happens down the road, I ONLY want Dr. Clavell to be my surgeon. I couldn't imagine going to anyone else. Thinking of not being able to go back to him made me extremely sad.

I'm so grateful Dr. Clavell called me and I cannot praise him enough. Spread the word. He is the MAN!

Also, thanks to all of you who responded to my original post. Your comments were very comforting and helpful. I have a huge weight lifted and am still feeling emotional about this.

[Txagq8]

I’m not surprised.

Regardless of your business…..medical doctor, car salesman, butcher, baker, candlestick maker…..a
good name is worth a fortune. It’s far more valuable than a few bucks.

I suspect Dr. Clavell has the clout and the volume of his practice is such that the hospital pulled in their claws and settled for a reasonable fee rather than stick him for the entire amount you were billed.

That doesn’t diminish the fact that he did the right thing and in this new modern era folks need to celebrate and ensure honesty, integrity, and good judgment are rewarded.

You’ve convinced me. Eventually it’s likely that my 4 1/2 year old LGX is going to reach its service life and I’ll want a revision. Yes, I will go see the guy who installed me originally as a courtesy. But I will also see Clavell and most likely make the drive down to Houston. Doing the right thing MUST be rewarded.

[Rider1400]

That’s truly AMAZING!! Not many Drs out there would do what Dr Clavel did for you! That’s definitely going the xtra mile in my opinion. I’m 27 months in and the day mine quits I’ll be calling Clavels office for a revision. I live in central Arkansas but will gladly make the drive to Houston to see the best Dr out there! I’ve thought this ever since I started following his videos and reading his bio. But this seals the deal.

[Journeyman]

I may be biased because he was my surgeon , but that guy is as genuine, compassionate and intelligent as his videos portray. He's the real deal and I'm happy to see him opening up his own practice ! Good luck Doc !

[Enoughisenough]

$366,000? Is that a typo? Holy shit!

Mine was 100% covered as-is my revision on Wednesday. I've never seen a bill so I don't know what it cost, but damn, that's a big freakin number!

[Old Guy]

Wow that is an amazing thing Dr. Clavell did. Glad you are off the hook for 366,000 dollars!

[Totitoti]

Amazing, cheers to you and there you and I think Dr Clavell deserves our recomendation.

[cbinspok]

Houston is where im headed when my equipment failes.
Clavell is Top notch. Thanks the report

[Witheringhog]

Congratulations!!!! What a nice thing.