Reimbursement

 i paid for my lower body lift last month, today got  letter from insurance approving it...Do i stand a chance Aetna giving me the money back ?? help... thanks im so mad, because im not rich at all. thank you all in advance...

Depends on how they run their payment regarding approvals - most times if you had the surgery before the approval - they won't pay it.   but you never know

Call and ask them. Hell - you can't lose anything - you already paid and the work is already done so the only possible direction is up! 

 THANK YU SO MUCH FOR THE REPLY..IM SO MAD RIGHT NOW ITS NOT FUNNY.. IM GOING TO TRY NOT TO OVER EAT BECAUSE I AM SO UPSET I WANT TO CRY...

It's also going to depend what you had done vs. what they approved. If they approved the panniculectomy only but you upgraded your procedure they may not.... But I would fight it and at least try to get the amount they would have paid for the approved service.

 THANK YOU SO MUCH FOR YOUR INPUT. THEY APPROVED THE LOWER BODY LIFT AND THATS EXACTLY WHAT I HAD DONE... I WENT THROUGH THE TEACHING HOSPTIAL FOR RESIDENTS SO IT WAS MUCH CHEAPER. TOTAL INCLUDING HOSPITALIZATION WAS LIKE 7000, SO IM HOPING THAT HELPS THEM DECIDE TO GIVE ME SOME BACK.....GOD THANKS FOR THE ENCOURAGMENT.

I think that's great!  You know I never tried to go through my insurance because they told me that I had to have like 3 or 6 months of documentation of rashes and such which I don't have.  I would definitely fight for reimbursement if I were you even if it's for some of it.  Actually, since you went through the school, it would cost them much less than had you gone through a private surgeon.  Have you asked them if they will reimburse you yet??

Melissa

 I JUST OPENED THE LETTER TODAY. I was totally done for the day, I was steamed.

There is no corresponding procedural code (CPT)  with insurance for a lower body lift per se. There may be certain elements (eg. a panniculectomy, a % of anesthesia costs, & hospital stay charges) ) that you may be able to get reimbursed for which are worth pursuing.  You will not get the whole procedure cost covered, I'd guess $2000-2500 might be a reasonable amount you could get back. 

Dr. Oliver thank you very much...for the information.  Im trying to cope with it now...

Ariel,

What exactly did you get approved for? That's where you need to start.

Then you'll need to look at a breakdown of charges for total surgery fee, anesthesia & hospital charges. You'll need to bring your partial coverage to the attention of all 3 parties offices so they can bill your insurance if they're in network for your plan. They'd be obligated to refund the balance to you for the difference in charges if they're providers on your plan. If they're not (which is less likely at a teaching hospital I'd think), you have to file the claim yourself and you'd get reimbursed directly. For the body lift  charges from your surgeons, you'd likely just get the difference between your cosmetic fee and the $$ paid on a panniculectomy claim ($1000-1800 usually depending on the plan). For anesthesia & facility charges, you may still have a split bill (part insurance/part self pay) and for the overnite stay in the hospital charge it should pick up the whole thing.