Surgical Services Group, Inc., a Texas non-profit healthcare corporation (“SSG”) operates the Surgical Stewardship Program, which among other things, is a care coordination and population health management program that is committed to improving patient outcomes and the quality of surgical care for patients by reducing the amount of revision procedures, decreasing infection rates and time spent under anesthesia and appropriately reducing healthcare costs for facilities, patients, providers, manufacturers and payors through comprehensive surgical data and digital health technology analysis services and certain value-based care coordination and population health management services, including coordinating and managing the care of certain patients, and connecting facilities, patients, providers, manufacturers and payors (the “Surgical Stewardship Program” and/or “Program”). In connection with the Surgical Stewardship Program, SSG is pleased to offer this Limited Warranty to certain eligible patients of participating surgeons that are actively enrolled in the Surgical Stewardship Program and meet all other required criteria set forth by SSG as set forth herein and in any other written agreement by and between SSG and the recipient.
SSG’s Surgical Stewardship Program only applies to patients that meet the criteria set forth herein. In the event that an Eligible Patient (as defined below) implanted with an Eligible Device (as defined below) is medically determined to require a revision on or before the one (1) year anniversary of the date of the original surgery, this Surgical Stewardship Warranty will provide such Eligible Patient with a one-time Warranty credit equal to the lesser of (X) forty-nine percent (49%) of the Eligible Device’s original invoice price, net of all discounts or (Y) the patient’s actual out-of-pocket expenses for the applicable plan year that are directly related to the original surgery (each a “Credit” and collectively the “Credits”); provided, however, that in no event will a Credit exceed $5,000. For the avoidance of doubt, each procedure will only be eligible to receive up to one (1) Patient Credit per qualifying procedure. Credits may only be for Eligible Devices and will not apply to any other devices and/or equipment used during the course of a procedure at an implanting facility.
To be eligible to receive a Warranty Credit, all of the following conditions must be met:
i. Each Eligible Device must be purchased by an implanting facility directly from a device manufacturer and such device manufacturer must have a written, definitive agreement by and between the implanting facility and SSG and/or an affiliate thereof and such agreement must (i) specify that (X) the device manufacturer is an eligible participant in the Surgical Stewardship Program and (Y) that the Eligible Devices purchased under such Agreement are eligible to be covered under the Surgical Stewardship Program (each a “Manufacturer Agreement”).
ii. The Eligible Device must have a registered implant date during the Program Term and such implant of the Eligible Device must be performed in the United States and at the implanting facility that purchased the Eligible Device.
iii. The Surgeon that performed the implanting procedure must have a duly executed Participation Agreement with SSG that is in full force and effect at the time of the original implanting procedure and such surgeon must have issued its own written bundled warranty to the patient.
iv. On or before the one (1) year anniversary of the date of the original procedure, the patient must have developed a medically necessary need for a revision that is directly related to implant or usage of the Eligible Device and not as a result of a chronic condition or something unrelated to the original procedure and such medically necessary revision must take place on or before the one (1) year anniversary of the date of the original procedure. To be eligible for a Credit, the surgeon performing the revision must provide an attestation of medical necessity and SSG shall have the right, but not the obligation, to have such claim reviewed and approved by a qualified third party.
v. Any surgeon, including the surgeon that performed the original surgery, may perform the medically necessary revision and the revision does not have to be performed in the same facility that the original surgery was performed in.
vi. The patient requesting a Credit must submit a Credit Request Form through the Surgical Stewardship Program Claim portal at marvelgp.com on or before the fourteen (14) month anniversary of the date of the original surgery and must provide all information requested under the Surgical Stewardship Program Claim portal at www.marvelgp.com.
vii. The patient must submit complete and accurate information through the Surgical Stewardship Claim Portal.
viii. By submitting information through the Claim Portal, each patient acknowledges and agrees that (A) SSG will determine if such patient is eligible for a valid Patient Claim; (B) all information is submitted voluntarily and is true and accurate in all respects; (C) SSG is authorized to contact the patient submitting the information on such patient’s cell phone, home phone and/or email address, each by electronic or computer assisted technology, including text message or any other form of electronic communication; and (D) the submitting patient will work with SSG and provide additional information to SSG that it may reasonably request and Patient will submit a signed Patient Claim form certifying to the accuracy of the submitting information.
ix. The patient must not have had a previous Claim request submitted under the Surgical Stewardship Program related to the same revision procedure.
The Surgical Stewardship Program is effective as of September 1, 2021, and will remain effective until terminated by SSG (the “Program Term”). The Program Term may be terminated in SSG’s sole and absolute discretion and SSG reserves the right to change or otherwise alter the terms and conditions of this Warranty, at any time, in its sole and absolute discretion. If the Surgical Stewardship Program is terminated by SSG, all implanting facilities and patients implanted with Eligible Devices during the Program Term will remain covered under the Surgical Stewardship Program until the one (1) year anniversary of the date of the original implanting procedure.
Each Warranty Credit issued hereunder will be issued within sixty (60) days of SSG’s final determination that all of the conditions to earn a Credit have been met. SSG will process and issue all Patient Credits through the Surgical Stewardship Program Claim portal at www.marvelgp.com. SSG will only issue one (1) Patient Credit per surgery and up to only one (1) Patient Credit for each eligible subsequent revision.
To the extent applicable, if any benefit provided by SSG under this Warranty represents a price reduction that a recipient is required to fully and accurately report pursuant to the warranty safe harbor provisions of the federal anti-kickback statute at 42 C.F.R. § 1001.952(g), recipient acknowledges and agrees it will take responsibility for fully and accurately reporting the same. Recipients of warranties must provide information upon request to Medicare, Medicaid, and other federal healthcare programs on price reductions (including free items), if any, obtained as part of this warranty. Each recipient will be solely responsible for determining whether any discount it receives must be reported to or passed on to payors. Benefit payments made to a patient are not in any way meant to entice the use of the Eligible Products. Recipients must fully and accurately report applicable benefits payments under this Warranty to be filed with federal or state health care programs in accordance with the warranty safe harbor provisions of the federal antikickback statute at 42 C.F.R. § 1001.952(g).
Except for the warranty specified in these terms and conditions, with respect to SSG and its affiliates, SSG and its affiliates expressly disclaim and exclude, and each eligible implanting facility and patient expressly waive, any representations, warranty, contract, covenant or other undertaking, negligence, tort, strict liability, statutory, express or implied or otherwise, written or oral, with respect to the Eligible Devices, quality, conditions, results, claims and descriptions, including, without limitation, any warranties of merchantability, non-infringement, durability or fitness for a particular use or purpose. For the avoidance of doubt, these terms and conditions of the Surgical Stewardship Program, and the benefits and remedies set forth herein, shall be exhaustive with respect to SSG and its affiliates, for the Eligible Devices, medical procedures related and incident thereto and the subject matter of these terms and conditions, and shall exclude any other rights, benefits and/or remedies, including, without limitation, reimbursement or payment of physicians, therapists, surgical, laboratory, radiological, hospital, rehabilitation and/or clinical treatments, costs, services, charges, fees; and/or travel expenses, or instrument, bone cement, product, device and/or equipment supply charges.
SSG reserves the right to modify or withdraw this Warranty and/or these Terms and Conditions at any time without notice. Any such modification or withdrawal will not affect any Warranty on an Eligible Device already implanted in an Eligible Patient prior to the date thereof. SSG may amend this Warranty in its sole and absolute discretion without notice.
Except for the limited warranty specified in these Terms and Conditions, SSG and its affiliates hereby expressly disclaim and exclude, and the recipient hereby expressly waives, any representation, warranty, contract, covenant or other undertaking, negligence, tort, strict liability, statutory, express or implied or otherwise, written or oral, with respect to the Eligible Products, quality, condition, results, claims and descriptions, including, without limitation, any warranties of merchantability, non-infringement (except for implied warranty of title), durability or fitness for a particular use or purpose. SSG and its affiliates further disclaims, on behalf of any of its representatives or other third parties that manufacture or distribute the Eligible Products, any and all liability with respect to pain and suffering, medical expenses, lost earnings, incomes or profits, failure of the healthcare provider, surgeon, anesthesia/ nursing / healthcare facility to conform to generally accepted standards of care, surgical procedures, techniques and practice, and any other direct or indirect, special, contingent, incidental or consequential damages resulting or arising from the design, composition, condition, use or performance of the Eligible Product(s). Notwithstanding anything contained herein to the contrary, if applicable, SSG and its affiliates’ total liability, if any, under or in connection with the recipient of this Warranty or caused in whole or in part by SSG or its affiliates, including for any breach of contractual obligations, breach of duty, breach of warranty, misrepresentations, misstatements or tortious act or omissions (including without limitation, strict liability, negligence and liability for infringement of any third party intellectual property rights) shall be limited to damages in not to exceed the benefit amount of Five Thousand Dollars ($5,000) provided for under these Terms and Conditions. For the avoidance of doubt, these Terms and Conditions, and the benefits and remedies set out herein, shall be exhaustive with respect to the Warranty and the subject matter of these Terms and Conditions, and shall exclude any other rights, benefits and/or remedies, such as, for example, reimbursement or payment of physicians, therapists, surgical, laboratory, radiological, hospital, rehabilitation and clinical treatment, costs, services, charges or fees; and/or travel, instrument, bone cement, product, device, equipment supply charges.
9. Additional Terms.
The limited warranty and/or Credits outlined in these terms and conditions are exclusively for the benefit of Eligible Patients, the limited warranty and/or Credits are not for the benefit of any other person or entity and cannot be assigned or transferred. This Surgical Stewardship Program Warranty is governed by and will be construed and enforced in accordance with the substantive laws of the State of Texas, without regard to its conflicts of laws principles. Any judicial proceeding brought by or against SSG and/or an affiliate thereof on any dispute arising out of the Surgical Stewardship Program Warranty or any matter relating thereto must be brought in any federal or state court sitting or having jurisdiction in the Tarrant County, Texas, and each person by use, participation and/or interaction, or attempted use, participation and/or interaction, under the Surgical Stewardship Program accepts for itself the exclusive jurisdiction and venue of the aforesaid courts as trial courts, and irrevocably agrees to be bound by any final non-appealable judgment rendered in connection with this Surgical Stewardship Program Warranty. Participation under the Surgical Stewardship Program is voluntary. Nothing contained herein, express or implied, is intended to confer upon any person or entity other than the parties referenced herein and their respective successors in interest and permitted assigns any rights or remedies.
For purposes of this Agreement, the following terms shall have the corresponding definitions:
“Eligible Device” means biologics and/or implantable medical devices, including spinal pathology and other implantable medical devices that are duly enrolled in the Surgical Stewardship Program pursuant to Manufacturer Agreements and are used in implanting procedures on Eligible Patients by surgeons who are active participants in the Surgical Stewardship Program pursuant to active Participation Agreements with SSG.
Terms and Conditions are subject to change at any time without notice.