
Medical device replacement
Donation protected
I need a internal medical device replaced. The needed amount is around $50,000. Insurance (UMR) told me the original surgery and device were a covered procedure, less than two weeks later the device failed and needed to be replaced. I called insurance again and confirmed that the procedure and device were in fact covered. I had the revision surgery and got the device replaced. After the second surgery, insurance notified me that the first surgery wasn't covered and then a few months later informed me that the second surgery was not covered, leaving me with a original bill of $186,000. Hospital then sends several bills with the amount fluctuating, until I finally get a bill for about $42,000. About a month later the second device fails, which requires removal and replacement that I can't afford and insurance isn't going to pay. I appeal the insurances decision to deny and ask that they pay for both previous surgeries and the needed revision. After a few months I get a letter informing me that they are reversing the denials. I call and ask about the revision surgery and was told to have the Dr request a pre-authorization pre-certification referencing the prior surgeries to have it done ( thinking ok they're going to cover this one too ). After several weeks I call insurance and get conflicting answers, so I call my companies HR and ask if they can have their UMR contact call me so we can all get on the same page. They call and tell me they are paying the prior surgeries and that IF I had had the needed revision when I found out and before the appeal, they would have covered it as well, but because I didn't ( Dr and Hospital wouldn't do it as insurance hadn't paid them yet ) that it was now up to me to "figure it out" and that a note referencing this surgery and that it was not to be paid was being put on my file. So insurance is dead set on leaving this defective device as is, and it's all due to their lies or misinformation that I'm stuck like this. To be clear UMR informed me not once but twice that this was a covered procedure, they told my Dr and the Hospital that this was covered ( both the Dr and Hospital informed me that if insurance had told them it wasn't covered that the surgery would not have been done unless prior payment had been made or setup ). In order to get this device removed and replaced as a self pay option I need to raise at least $50,000 to pay for all costs up front before anything can be done. Anything will help. Thank you so very much, even if it's only just sharing this.
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Organizer

John Cantrell
Organizer
Macon, GA