ASR™ Hip System Recall
Reimbursement Guidelines

DePuy intends to cover reasonable and customary costs for testing and treatment of patients, including revision surgery if necessary, associated with the ASR™ Hip System recall. DePuy will also reimburse the patient for reasonable out-of-pocket expenses incurred as a result of the ASR recall.

Patient Expenses

Bills for services should be submitted to payors (public or private) in the usual manner, and then DePuy’s intended process is to reimburse payors (public or private) for reasonable and customary expenses. Negotiations around the specifics of this process are in progress. Detailed information about the reimbursement process will be available shortly.

Patient expenses include out-of-pocket costs incurred by the patient for reasonable and documented expenses, which may include, but are not limited to travel expenses and other reimbursable expenses.

Timing

DePuy will reimburse if the ASR revision occurs within 7 years after the initial implantation. DePuy will reimburse for blood ion tests/MRI/ultrasound scans if the monitoring occurs within 5 years from the date of the recall.

Patient Eligibility for Reimbursement

Reimbursement is subject to the completion and submission of required documentation to Crawford, DePuy’s claims processor, to confirm eligibility. Eligibility will be determined, in part, by validation that the patient has an ASR component implanted and that the treatment is associated with the ASR recall. To facilitate this validation, we are asking for the patient to consent to provide DePuy/Crawford with x-rays, explants and other related medical information after the revision surgery.

Medical Reimbursement Guidelines

DePuy will provide reimbursement for the reasonable and customary costs of tests and treatments related to the ASR recall and subject to review, which may include, but are not limited to blood testing, CT scans, ultrasound scans, MRI scans, x-rays, and revision surgery costs if surgery is necessary. These expenses should be submitted through Crawford for review of eligibility. A claim number and handler will be assigned so the claims can be processed.

Exclusions

The following surgeries may not be covered, subject to DePuy’s review:

· size mismatches

· traumatic injury where there is no evidence of soft tissue reaction at the time of surgery

· femoral neck fractures, where the fracture occurred within three months of primary surgery, and subject to review on a case-by-case basis.

Reimbursement will not be offered in those instances of infection confirmed through positive culture.

ASR Revisions Performed Prior to the Recall

All ASR revisions, whether or not they occurred before the recall, will be covered subject to DePuy’s review as well as the previously mentioned exclusions or other reasons unrelated to the recall.

Public and Private Healthcare Reimbursement

DePuy intends to reimburse both national healthcare providers and payors (public or private) for reasonable and customary expenses related to eligible ASR revisions.

Uninsured Patient Claims
Patients should call the claims centre and initiate a claim whether or not they are insured.