$40k of $250k Conor Heun medical bill denied by carrier
In May of 2011 UFC and Strikeforce parent company Zuffa, LLC, announced that the then nearly 350 fighters on its roster would receive health insurance for injuries suffered in training (or competition).
The insurance carrier denied approximately $40,000 of $250,000 in billable procedures for the claim of Strikeforce fighter Conor Heun, as they felt that the condition was due to a preexisting susceptibility to the injury. The procedure they denied was one to correct the condition that would undoubtedly lead to other injuries like the one he sustained against Ryan Couture.
Heun provided details, via the UG.
From: Conor Heun
Member Since: 2/27/06
As some of you may know, I needed surgery to repair the torn labrum in both of my hips, as well as an avulsion fracture, following my bout with Ryan Couture in Strikeforce this past March.
Unfortunately, Zuffa's Insurance company has denied a portion of the claim so I am being forced to pay out of pocket to cover part of the surgeries.
Luckily, the guys at Fund-A-Fighter have stepped up to help me be creating a campaign to help me raise the money.
All of my friends in the MMA community have really stepped up to offer some amazing prizes and incentives for those who contribute.
If you can't contribute, help me out by spreading the word, bumping this thread, and sharing this link for me on Facebook, Twitter, etc.
Please feel free to share the link on any other forum you guys are on.
Thanks so much for the support.
The fans are what makes this sport special.
The surgeon looked at the two torn labrum and on one side he said that I had a mild case of congenital hip dysplasia.
He said that if he just repaired the labrum, that I would be at risk of re-tearing it so he performed a PAO or Periacetabular Osteotomy.
This was to prevent the injury from happening again.
The insurance denied that claim based on this being a pre-existing condition not related to the fight.
The reality is that the injury (torn labrum) was related to the fight and the doctor just wanted to make sure that once it was healed, that it didn't happen again.
However due to stipulations in the Zuffa Insurance they are denying the claim because the PAO wasn't to repair an injury, but was to prevent re-injury after the initial repair.
I am currently still under contract with Zuffa.
In fact, Sean Shelby called me this afternoon to offer my the fight with Pat Healy on Jan 12.
I told him I'd take the fight but that they'd have some trouble getting me cleared buy the doctors as I'm still on crutches and will be until Jan 3rd.
He said that if I beat Pat, they would bring me to the UFC.
When he found out that I was injured, he told me that I would not be brought over to the UFC but to get a win at 145 after I'm healed and they will look at bringing me on.
I was flattered to get the shot at Healy, a title shot has always been a dream and yea, I'm crazy (and broke) enough to take that fight even in the shape I'm in.
So while I am officially still under contract with Zuffa, I was told to expect my release early next year.
The UFC did cover the majority of the costs.
The first two surgeries where already done when they notified me about the insurance's denial of the claim.
The problem was the procedure was half done, I had hardware (screws) that needed to be removed from the right hip, and still had to repair a fracture and torn labrum on the left side.
I am only being forced to pay for the final surgery.
The irony is that the final surgery, the one I'm being asked to pay for, wasn't the PAO.
This final surgery was to remove hardware they had placed earlier (as part of the PAO), and to repair the damage to the labrum and the pelvis on my left side.
No one is disputing that the damage to the labrum and pelvis where sustained in the fight, at least not to my knowledge.
So far the bills I have received are for $2,648.00 for Physical therapy which I have discontinued, and one for $37,950.00 from the hosipital, anesthesia, arterial catheterization, spinal injection, and PRP.