Not since the days of Monica Lewinsky has parsing the meaning of a word—or two in this case—been worthy of such scrutiny. The words, “if necessary” in this “Claims & Reimbursement FAQs” link on the Stryker website should perhaps make any hip replacement patient who’s been affected by the Stryker Rejuvenate and ABG II modular-neck hip stems recall suspect.
Well, a little walk down memory lane on LawyersandSettlements.com brings up a story we had published back when Broadspire was the third-party claims administrator brought in by J&J to handle DePuy hip replacement claims.
At the time, a Reuters article noted that the move means that Broadspire’s physicians—not the patient’s physician—will determine whether a hip should be replaced. This means that even if the patient’s physician recommends replacing the hip, if a Broadspire physician disagrees with the decision, Johnson & Johnson may not pay to cover the costs of that surgery.
So is history repeating itself?
Clearly by inserting the words “if necessary” in discussing defective hip replacement revision surgery reimbursements Broadspire retains the right to deem whether a revision surgery was necessary, or not; the “not” undoubtedly necessitating a denial—or reduction—of reimbursement.
What we’re hearing from attorneys like Ben Stewart of Stewart Law Group PLLC., who’s familiar with defective hip lawsuits, is that before a patient submits any paperwork with Broadspire—or signs anything—for a Stryker hip reimbursement claim, he or she should first talk to a lawyer.