If insurance covered the panni portion of your TT, how much did you have to pay?

I'm so frustrated with this whole process.

I was thrilled to get approved for the panni removal. For out-of-network, my coverage is 70% after a $2,000 deductible.

I saw two out-of-network surgeons - 

#1 - who I'm not interested in using, gave me a quote of $9,600 for a full TT but couldn't really estimate how much of that would be covered by insurance. (I'm suppose to go thru surgery blindly, not knowing how much I'm going to have to pay!?)

#2 – who I REALLY want to use, gave me a quote of $12,000 and said only expect insurance cover about $2,000 for the panni portion.

It was a chore but I found an in-network surgeon with a good reputation, although not too much experience with massive weight loss patients. He said my full TT would be about $8,000 out of pocket, after insurance!!

How is that possible??

I just wanted to get an idea of what others have had to pay. I know it can vary by location and insurance coverage.

After just spending $11,000 on a new roof, I'm not going to be able to afford plastics for awhile at these prices.

Anyone have just the panni removal? Are you happy with the results? Is it worth it to go thru all that just to need a revision down the road? My muffin top is almost as big an issue for me. All surgeons agree that I need the anchor cut.  I'm pretty confident I would be disappointed with just the panni removal but would I be happier than I am now?

I am scheduled for tummy tuck on November 18th  my surgeon does not do panni he does the full anchor tummy tuck.. my cost out of pocket 3500..  lets hope its money well spent..

Good Luck

Nat

My insurance is covering my TT, so I don't have answers for you there-  I just wanted to cmmiserate, lol...I live in NY too...and even though my TT is covered, the BA I am doing at the same time isn't.  The national average for a BA is $4000, but even considering the discount I get for already being on the table, I have to pay $6000...apparently NY is just the most expensive place for plastics!

Have you looked into paying out fo pocket and going to MX?  The prices you have been quoted WITH your insurance may be higher than just flying to Dr S..I think his wesite lists a TT at around $4000...just a suggestion!

I can beat that!  In So CA I got a quote for a Breast lift along with a insurance-covered TT for more than $10K!  Makes you wish you lived in another state sometimes!

Last year I was supposed to have an insurance paid panni and paid 5K out of pocket to upgrade.

He only did the panni and kept my money.  I ended up with complications and had UHC approve an anchor cut TT - they paid out $8,725 for it - my out of pocket was $500.

I know Dr. Sauceda quoted a price of about $8500 for a Tummy tuck and a breast lift with aug.  He is a great surgeon and it's also what I can afford.  I couldn't get both of these things paid for by my insurance and it's possible they would pay for the panni removal but my out of pocket would definitely be higher than going to Dr. S.

Let me see if I can explain this as I was told. NOTE: NUMBERS ARE JUST EXAMPLES AND ALL ARE MADE UP!!!

LBL = $8000
Ansth for LBL - $3000
Other hospcosts for LBL $1000
Total cost for LBL - $ 12000

TT = $5000
Ansth for TT - $2500
Other hosp cost for TT $1000
Total cost for TT - $8500

Insurance contracted price for TT - $2000
Insurance contracted price for ansth - $1000
Insur contract for other hosp cost - $500
Total insurance contracted price - $3500

So..... While the doc charges $8500  for the TT, the insurance will only pay him $3500 - he has to write the rest off. However, a lot (not all) docs who add in procedures will recoop the cost that they lose by doing math this way:  My charge for an LBL: $12000. Your insurance will pay $3500 of that (for the panni) making YOU responsible for the other $8500.

This math totally sux for the patient though because you're stuck paying the $5000 that the insurance contracts require the doc/hospital to write off.

Does this make sense?

Some docs will do the math a much better way and say you are just responsible for the additional cost over the amount a TT would cost (totalling $3500 in this case). But it's all up to how the doc does the math.

Again, I just made these numbers up because they were easy to add, but hopefully you'll get the drift of the message.

Cass

EDIT: By going to an out of network surgeon, it's even worse, the insurance STILL will only pay their reduced % of their "maximum allowable charge" but since the doc is out of network, he is under NO obligation to write of the amount exceeding their max charge making you responsible for your 30% of the max, $2000 AND any amount over the max (in this case the $5000). So in this case you would be responsible, even just doing the tummy tuck of $7450 of the $8500 for the tummy tuck. (You pay anything exceeding max allowable ($5000) AND the first ($2000) AND 30% of covered cost ($450) of the $1500 the insurance would actually pay = $5000+$2000+$450=$7450 amount due from patient).  Now add in all the additional costs of the LBL.

Please check with your insurance company... if your doc participates, they can not do a different procedure than what is being paid for. Each surgical procedure has it's own 'code'... therefore a "TT" will have a different procedure code than a panniculectomy. A participating doc can not do a full TT and bill the insurance company for a panniculectomy and then balance bill you a difference. Participating docs have signed a legal binding agreement with the insurance carrier that they will accept the insurance companies payment as payment in full and only balance bill for any applicable copay/ coinsurance. Legally it's 1 or the other. Pay for the uncovered TT out of pocket or an insurance billed panniculectomy.

I know several people who have "upgraded" their procedure and still had the insurance pay for a portion. I also spoke with a couple of doctors on other procedures of how this worked. The way it was explained to me is the bill submitted to the insurance company would look like

XXXXX - Code for "covered procedure" (IE "panni")
XXXXX - code for "other surgical services" - (non-covered charges)

And they wouldn't code it differently under one consolidated code like LBL, it would still have the panni code. Then when the bill goes to insurance, they pay the panni and other covered codes but say "we do not cover services for "other surgical services" patient is responsible for these charges".

At least that's how both my current and my old insurances worked when I checked into them.

Cass

Incorrect. Panniculectomy and abdominoplasty CPT procedural codes are distinct and it is standard practice and consistant with insurance contracts to balance bill fee-for-service for cosmetic elements of the procedure.