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Absolutely no luck for revision

Posted: Thu Sep 26, 2024 2:52 pm
by JohnHC
Well I have absolutely no luck for the revision I need. Boston Scientific lawyers told me they'll supply the new implant under warranty, but any other out of pocket expenses won't be paid until and unless the device is removed and sent to them for analysis. So I'm stuck in the catch 22, can't pay it, but need it, they'll most likely pay once they figure it out ( unless it was Dr's error ), insurance paid for my first two but refuses to pay for the revision even though all this mess is their fault for lying to me ( told me and dr/hospital it was a covered expense then denied it over 2 months later after the second surgery ). So started a GoFundMe ( https://gofund.me/e81bf73b ) and yes the amount is high I'm asking for as I still have some costs to cover from the previous two surgeries. If I can raise the money, guess I'll be going to Dr Hakky in Atlanta and I know his self pay is around 30k. I hate having to go to a different Dr and go through all the paperwork, tests etc all over again but Dr Hakky's self pay price is much better than my current Dr/anesthesia/hospital bill would be. Nothing worse than to be in this situation and possibly be stuck this way for the next 8 years or so until I can get coverage by Medicare.....

Re: Absolutely no luck for revision

Posted: Thu Sep 26, 2024 4:53 pm
by jwdetails
JohnHC wrote:Well I have absolutely no luck for the revision I need. Boston Scientific lawyers told me they'll supply the new implant under warranty, but any other out of pocket expenses won't be paid until and unless the device is removed and sent to them for analysis. So I'm stuck in the catch 22, can't pay it, but need it, they'll most likely pay once they figure it out ( unless it was Dr's error ), insurance paid for my first two but refuses to pay for the revision even though all this mess is their fault for lying to me ( told me and dr/hospital it was a covered expense then denied it over 2 months later after the second surgery ). So started a GoFundMe ( https://gofund.me/e81bf73b ) and yes the amount is high I'm asking for as I still have some costs to cover from the previous two surgeries. If I can raise the money, guess I'll be going to Dr Hakky in Atlanta and I know his self pay is around 30k. I hate having to go to a different Dr and go through all the paperwork, tests etc all over again but Dr Hakky's self pay price is much better than my current Dr/anesthesia/hospital bill would be. Nothing worse than to be in this situation and possibly be stuck this way for the next 8 years or so until I can get coverage by Medicare.....


sorry brother - that's really a F'd up situation. Have you looked surgeo application or even going outside the country. Cash pay could be as low as 15-20k even in the US (although with another revision I know its important to have a lot of faith in your surgeon and Hakky would make sense)

Re: Absolutely no luck for revision

Posted: Thu Sep 26, 2024 4:56 pm
by Thisworld
Man, truly consider karaman in turkey. 8k for the full thing. Just saying

Re: Absolutely no luck for revision

Posted: Thu Sep 26, 2024 5:38 pm
by JohnHC
Well evidently I might have stepped on toes at work after emailing the CEO about my situation. I called them out today after 3 weeks with no response and the HR director and our Chief People Officer want to talk and bring me up to date on their efforts and our general councils efforts to explore options against UMR and the false information UMR gave me. Another update in this long and stressful event coming soon.

Re: Absolutely no luck for revision

Posted: Fri Sep 27, 2024 10:47 am
by HikerMan
JohnHC wrote:Well evidently I might have stepped on toes at work after emailing the CEO about my situation. I called them out today after 3 weeks with no response and the HR director and our Chief People Officer want to talk and bring me up to date on their efforts and our general councils efforts to explore options against UMR and the false information UMR gave me. Another update in this long and stressful event coming soon.


Wow, is there a lesson to be learned here.

To all forthcoming implant recipients:

Do NOT proceed to the operating table without making sure this is paid for ahead of time.

Sorry for your situation, John

That bill is going to be brutal if they can't figure this out.

Re: Absolutely no luck for revision

Posted: Fri Sep 27, 2024 10:52 am
by Jage64
Unless there's been a change in the last 18 months, Dr. Clavell is considerably less than $30k for self pay.

Re: Absolutely no luck for revision

Posted: Fri Sep 27, 2024 12:44 pm
by easymoney
JohnHC .... Consider going with a mallabble implant ..less chance of failure 3 to chose from I have a Rigicon for the last year ...cheaper .. less chance of infection .. look up a guy on here call thedriver .. had 4 failed implants put a Genesis mallabble and he and his wife are load testing the shit out of it and if you contact him I'm pretty sure hw would answer any questions you have .. good luck to you ..

Re: Absolutely no luck for revision

Posted: Fri Sep 27, 2024 12:57 pm
by ED2013
Contact Dr. Karpman. Great surgeon and self pay cost is reasonable.

Re: Absolutely no luck for revision

Posted: Fri Sep 27, 2024 3:24 pm
by JohnHC
Well they are going to try to get this taken care of sooner than later. They got my info and said that if UMR doesn't budge they may just have me go to Dr Hakky and see about that route. They know Boston is saying they'll supply the replacement device which is a plus and will make whatever the payment is cheaper. They ( my HR )know how long I've been trying to get this that's why they are pushing UMR through our legal team to make this right. Because of the first 2 lies if they had listened to me they would have only had to pay about 42k since that was my bill through the hospital and I had settled with my Dr. But they went through all the billing and paid the full price for both devices and surgeries etc to the tune of 186k. They said they know this is time sensitive and wanted to know if it was critical and will give an update next Wed on it's status. I told them it's been broken since Jan so it's not that imperative but sooner is always better than later. I told them I had looked at Dr Hakky but would have to pay his $400 consult fee and I didn't have that money just for him to tell me what I already knew. My only issue with Hakky is he appears to be a Coloplast person vs me being AMS. But it's in the right direction though.

Re: Absolutely no luck for revision

Posted: Thu Oct 03, 2024 12:15 pm
by JohnHC
HR notified me that today they, our Broker, and company lawyers are meeting with insurances lawyers to get a resolution on this mess. So I'm obviously hoping I hear good news today or tomorrow. HR has pretty much told me if insurance ( UMR ) won't budge that they are looking at other ways to fix this...