Patient Questions Insurance Coverage Following Hip Replacement

The sharp pain in Glenn Laken’s hip came “out-of-the-blue” last summer. The health-conscious Chicago resident soon found himself unable to walk.

“I was bed-ridden for about a week,” Laken said.

Laken, 64, underwent a successful hip replacement surgery in August. However, he recovered just in time for a battle with his insurance company.

Texas-based Freedom Life was refusing to pay for the majority of Laken’s $35,000 surgery, according to an explanation of benefits he received in November. The EOB included an explanation that said durable medical equipment and medical supplies were not covered under his policy.

“If you weren’t going to pay for the hip to be replaced did you expect that they were going to saw the hip out of me and that I was going to crawl off the table with my leg hanging by a piece of flesh,” Laken said.

Laken said he signed up with Freedom Life several months earlier and was assured that coverage for hospitalizations was “rock solid”. He also said that his insurance authorized the hip replacement procedure before he went to the operating room.

“This has taught me a lesson that you can’t assume anything,” Laken said.

NBC 5 Responds contacted a Freedom Life spokesperson, who said the company would investigate Laken’s concerns. The spokesperson also said the company would take care of Laken as best they could under the terms of his coverage plan.

Still, consumers have the right to appeal their medical bills.

“Don’t pay the bill if you don’t believe that you owe the money. Don’t cave in to the system,” said Avrom Fox of Chicagoland Patient Advocates.

While patient advocates are not allowed to broker insurance coverage, they can help consumers challenge insurance companies if needed. However, Fox said consumers can avoid potential insurance disputes before heading to the hospital by getting a second opinion and getting insurance verification in writing.

“Enter into the arena as if you’re not covered at all,” Fox said. “Even though you’ve got a thick insurance policy, you’ve got to know where you stand.”

Additionally, patient advocate Jim Poynton said consumers should research the cost of a surgery beforehand and realize that costs can vary between hospitals. Poynton said if a surgeon has privileges at other hospitals, consumers should find the safest and least expensive option.

“You are the consumer and the patient. You have every right to ask as many questions about your surgery. After all, it is you that has to live with the outcomes and the bill,” Poynton said.

Several weeks after NBC 5 Responds contacted Freedom Life, Laken said he was told that the hospital was paid and he was no longer on the hook for the medical bill.

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