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Case Study - Insured - Coverage Rejected

Wayne King - 2-Level Total Disc Replacement
 
Wayne King, a 35 year-old insurance agent from central California was suffering from chronic back pain following an accident from several years before. As his pain continued to worsen, he began to seek aggressive medical treatment options. Finally an orthopedic surgeon recommended a 2-level Total Disc Replacement (TDR) to alleviate his pain. Wayne was quite relieved knowing that the end of his back pain was within sight. Then to his complete astonishment, just 4 days prior to his surgery date, his health insurance agent informed him that they would not cover the cost of the surgery because they saw it as experimental in nature.

Wayne immediately contacted the hospital to see how much his procedure would cost in total. He was told that without insurance, this procedure would cost over $100,000. This news was devastating to Wayne, as he did not know how or where he could come up with this kind of money in a short period of time. Faced with such incomprehensible anguish, Wayne decided to proceed with the operation in 4 days and then immediately file for bankruptcy protection. This worst-case scenario would at least alleviate his pain and then he would deal with the financial ramifications later.

After a few hours of considering this option, Wayne decided that there had to be a better and more responsible option. He then turned to the Internet to search for possible answers. This is where he learned the idea of obtaining his surgical procedure outside the U.S. by a highly qualified surgeon at a highly reputable hospital at a fraction of the cost in the U.S. This appeared to be a possible solution to his suffering.

Armed with this new information, Wayne began researching the top international hospitals on line and then submitting inquires to them in order to ascertain the price and doctor qualifications. Although this new possibility was very encouraging, he quickly discovered many obstacles in navigating the vexing challenges in communicating across borders. Not only was he dealing with vast time differences, there was also the cultural and language nuances that had to be overcome. One renowned international hospital quickly responded, but advised Wayne to fly half-way around the world for a consultation with their orthopedic surgeon to see if he was indeed a candidate for the surgery. Wayne clearly saw that this was a huge risk in time and money to simply go there to see if he was a candidate. Again Wayne figured that there had to be a better and more efficient path to receiving his surgery abroad, so he continued his search.

To his delight, Wayne found a US-based medical tourism service agency offering full service assistance in obtaining medical procedures abroad. This seemed like an excellent solution to his communication obstacles. Immediately after contacting this agency the process was set in motion. Their highly structured process provided for a seamless transition of all his medical documents, including MRI scans and reports. Within a very short period of time, Wayne was provided with a detailed array of information about the surgeons, the hospitals and the destinations. After carefully reviewing all the information, Wayne selected a hospital in Thailand based upon the credentials of the orthopedic surgeon. Of critical importance to Wayne, however, was finding a surgeon with significant experience in 2-level TDR. At a total quoted cost of $29,000, Wayne was prepared to move forward quickly this option. However, a few days later, the surgeon at the Thai hospital rejected his case as he did not feel that Wayne was a good candidate for the TDR, even though 2 orthopedic surgeons in California felt that he was. Discouraged by this setback, Wayne discussed his options with his program manager at the medical travel agency that he was working with. Since the agency already had all of his medical documentation in digital format in a secured file, they agreed to continue their search for other surgeons that would accept his case.

The agency quickly came back to Wayne with another option in Malaysia. Wayne was very hesitant at first because he was not too familiar with Malaysia. He agreed to consider this option and began reviewing the information that the agency sent him. To his surprise, the destination and the hospital greatly impressed Wayne. However, he immediately noticed that the surgeon had no experience with 2-level TDR, which was unacceptable. The agency conveyed to the Malaysian hospital that Wayne was not interested in moving forward due the lack of experience of their surgeon.

To Wayne’s total amazement, the Malaysian hospital followed-up two days later to inform him that they had contacted the most experienced surgeon in 2-level TDR’s in Malaysia and were willing to fly him in on the day of the surgery to perform the surgery along with their in-house orthopedic surgeon. This surgeon had performed over 200 2-level TDR’s and is considered among top spinal surgeons in Southeast Asia.

After reviewing Wayne’s MRI scans and reports, this surgeon agreed to proceed with the operation and scheduled the procedure in just 6 short weeks. The hospital and surgical team recommended a 7-day stay in the hospital and 14-day stay in Malaysia, after being released form the hospital. Wayne’s medical tourism agency immediately began planning all the logistics, which included a complete timeline, flights, hotel reservation, ground transportation, along with detailed information about all the pertinent items that he would need for his medical retreat. The total price for everything, including flights and hotel stay came in at $25,000.

Five weeks later Wayne was on a plane bound for Malaysia where he would be having his 2-level TDR by a world-class surgeon. His procedure was a 100% success. In fact, the surgery went so well, that he was released from the hospital a day earlier than planned. His surgeon was so pleased with his progress that he was allowed to safely return back home to California one week early.

Three months later, Wayne King is pain-free and enjoying his busy life. Instead of filing for bankruptcy protection and becoming a financial liability to our dysfunctional healthcare system, Wayne discovered a safe and innovative solution to his pain, had an experience of a lifetime, and saved tens-of-thousands of dollars at the same time.

“When my insurance agent told me that they were denying my claim 4 days prior to my scheduled TDR procedure because they saw it as experimental, I felt as if the world was pulled out from under me. I was devastated to say the least, as I was facing a medical bill of over $100,000. Then through my own initiative, I finally found MedRetreat, a US-based health tourism service agency that helps Americans with identifying top-notch hospitals & doctors outside the U.S. and then seamlessly connecting them with their highly organized process. I cannot say enough great things about my ENTIRE experience with MedRetreat. From the beginning planning stages to the day that I returned, they were there constantly ensuring that everything went smoothly.”  Wayne King

Video Interview with Wayne King: http://link.brightcove.com/services/link/bcpid1544602725/bclid1540999549/bctid1549643947

 
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