A Closer Look at the DePuy Hip Replacement Recall Claims Process

DePuy Orthopaedics, in response to its recall of the ASR XL Acetabular System and the ASR Hip Resurfacing System, has established a claims process aimed at covering the “…reasonable and customary costs of treatment if you need services associated with the recall.” On its Web site, DePuy identifies the following steps to be taken by ASR recipients seeking reimbursement:

1. Call the ASR Call Center.
2. Confirm whether you were implanted with an ASR device (to find out this information, you should contact your surgeon or the hospital where your surgery took place).
3. Speak to a Call Center representative, who will initiate a claim on your behalf.
4. Wait to be contacted by a claims representative who will send you a letter of payment authorization, an ASR claim number, and a medical authorization form.
5. Visit your orthopedic surgeon for evaluation and/or treatment.
6. Submit expenses and documentation to the DePuy claims processor for review for eligibility.

While the process described above appears to be straightforward and well-intentioned, a closer look reveals that aspects of the claims process could prove to be very sticky for ASR injury victims. In order to help you understand why this is true, it is useful to take a closer look at one particular component of the DePuy hip replacement claims process and the reimbursement policy itself.

The Medical Authorization Form

According to DePuy, signing a medical release form allows your surgeon to share information about your case with DePuy and the claims processor (a third party hired by DePuy), as well as allowing DePuy to share information with you about your ASR hip. Ostensibly, this will help the claims processor handle your claim more efficiently while access to testing data (such as the results of your blood test, imaging [MRI, ultrasound, X-ray] and revision data [related to your follow-up hip replacement procedure, if it is necessary]) will assist DePuy in its efforts to understand why the ASRs have an abnormally high revision rate.

You should be wary of signing this medical authorization form without first letting a hip replacement lawyer review it. DePuy may be telling the truth when it states that the form provides a means to “…share information about the patient’s case…”. You, however, have no guarantees that DePuy won’t try to use information in your medical records to devalue your claim. A lawyer can make sure you do not sign away any important rights.

Reimbursement

You should know that even if you obey DePuy’s wishes and carefully follow every step in the claims process, DePuy alone has discretion over whether you are reimbursed, and in what amount. DePuy admits as much when it states that costs borne by patients, such as co-pays, lost work time, travel expenses and other reimbursable expenses are “…subject to review on a case-by-case basis.”  In other words, you have no way of knowing whether you will be reimbursed for out-of-pocket expenses, not to mention that DePuy has yet to address compensating ASR victims for pain, suffering, and other non-monetary losses.

To be fair, DePuy states that it is still working out the particulars of its reimbursement process, and that more information will be available soon. But this is certainly not a reliable promise. Besides, do you really take at its word a company that already delayed a recall and rushed its product through to market without testing, endangering your health for the sake of profit?

At the very least, it’s reasonable to assume that there are some inconsistencies between what DePuy is saying it will do, and what it actually intends to do. To help you separate fact from fiction, consider speaking with a DePuy hip replacement lawyer about your case. Despite DePuy’s promise to do the right thing, you may find that filing a lawsuit is the only way to hold the company responsible for the harm it has caused you.