PS - Asking for reimbursement

Hi, Hope you can help me figure this out.  I am scheduled for TT this Thursday.  My PS doesn't do any pre-authorization request and says that he will give me a report if I want to file "after the fact."  I didn't try to get any reimbursement last Dec for my arms, but I would love to get something back for the TT, even if its just for the Panni. I have BCBS Feds, the same plan that covered my RNY. So my question is --- what are the necessary documents I need to file a claim and do you think its worth it to call BCBS to let them document my file that I am having surgery this week? Thanks - happy holidays to all

Congratulations on your surgery. Before filing a claim, you might want to check with your benefits matrix or schedule of benefits to determine whether the surgery will be covered in the first place.  If it is not, then reimbursement will not be an option for you. If you find that it is reimbursable, then you should be able to obtain a member's claim form from your insurer's Web site.  You can contact the customer service department to obtain one, too. When submitting a claim, include all medical documentation associated with the surgery, including diagnosis codes and procedure codes.  All doctor's notes should be included as well as payment information. Something also to consider about reimbursement is whether your surgeon is in network or not.  Based on the information you have provided so far, it looks as if he is out of network.  Please note that your reimbursement level will be based on the out-of-network tier, which is typically reduced when compared with in-network reimbursement.   Coupled with that, please note that your insurance company will reimburse you according to usual and customary rates, which essentially is the average rate that other doctors in the geographical area are charging.  What that means for you is that if you chose a doctor who charges dramatically higher fees than other doctors, your reimbursement will be based on what the other doctors are charging, not on what your doctor is charging. I hope I was able to assist you.

Thanks for your reply. He is in my PPO network, but because it is plastic surgery, his office does not get involved in the preauthorization aspect.   They do play the role of advocate for the patient.  I did call BCBS CSR and they will be sending me a claim form.  I have heard and read on this board that when having a TT, that is self-pay, BCBS FEB will pay for at least the panni, especially if you lost 100lbs, and if they paid for the GBS.  Wish me luck for some reimbursement. Any amount will be appreciated, 14 hours to go!!!!