Confused after PS consults in San Antonio (long rant/vent)
A few months back I attended a 'free' initial consult seminar with one local PS. I didn't get warm fuzzies from him.. Although he is recommened, his whole set-up came across to me like a used car salesman. " Upon initial consult here is what I would suggest and here is my price... But, if in the next 48 hrs you book your full $150 real consult, I'll knock 20% off the total surgery price!".
His prices seemed a little high to me based on some of the numbers I have heard from others in the Central Texas area (even after the 20%).. Plus he wouldn't even attempt to submit to insurance. I understand he doesn't want the hassle of the ins companies - but his whole demeaner just came across kinda slimy to me LOL
Since then, I did my reasearch on my insurance company (Aetna Open Access - Federal emp plan) and they will cover the Panni removal if deemed medically necessary. I printed off their CPBs for Cosmetic Surgery, Abdominoplasty, and Breast Reconstruction. I have the dates that I saw my doctors for rashs (including a recurring NASTY bacterial infection I get in my Belly button that smells like rotting flesh
). I have the xrays of the lump that was removed from my right breast in 2008 (to try to ask for reconstruction).
Today I had another consult with one of the PS's recommended by my WLS surgeon. This guy is highly recommended and his brother (in the same practice) did my Breast Reduction way back in '96, so I know their work personnally. Right now he does "mostly" post WLS body countouring with plans to move to only this market soon.
I should have known they wern't going to be "insurance friendly" when the lady I set the appointment with on the phone was very combative when I even mentioned that I wanted the initial visit billed to the insurance (cause my ins comany will allow this - I checked). But I know not to discount the quality of Doctors due to their rude office staff - one of my favorite Dr's has horrendous staff, but she is wonderful.
I got to the office and the staff had already called my insurance and asked if the panni was covered and they were told no. When I explained that it was no- unless medically necessary - they didn't seem to think I knew what I was talking about.
His suggestions were right along with what I already knew I wanted, a full Circumferential Body Lift, breast lift, and he even suggested 'augmenting' my rear (which is something I didn't have even when I was a teenager LOL). He and I both agreed that my arms were very minimal and didn't need to be done and that my inner thighs would smooth out to an acceptable level with the LBL.
He said he saw the note that nothing was covered, but said he understood that I had different info. He said that is was maybe possible to bill the Panni to the insurance and me pay the difference of the rest... and I told him I was cool with that and that was what I had figured i'd have to do.
So he left and I went into the money ladys office. I recognized her voice as Ms Grumpy from setting the appt. She gave me his prices, the LBL seperate ($14K), the BL seperate ($7K) and then a combined price ($21K). She mentioned that he does the procedure alone, I asked if that was normal (since I had heard it was usually a 2-Dr procedure). She, again got offened at my question and said that they could add in an assistant if I wanted, but the price would be significantly higer if they did (additional $3,200). Add to that, his prices were higher that the used-car salemans pre-discount price.
When I asked about the Dr's suggestion about billing the Panni to the insurance she looked at me like I was from Mars.. I told her it was his idea. she kinda flaked out and fumbled around her desk saying that she would have to cal the hospital and ask them how much it would change the price since it would be billed though them. (huh?) I asked if she could even give me a ballpark figure and she said it wasn't possible to do that until contacting the hospital and even finding out if the insurance would cover it.
I know there are other Plastic Surgeons in San Antonio and my WLS surgeon has a couple of others he recommends...
BUT do I have to go through all of this with each Plastic Surgeon after already paying the copay?
Is there a way to get them to let me know IF they are even willing to submit the procedures to the insurance companies and then deal with the results?
I know getting this covered is a crap-shoot, but i'd at least like a Dr that would try.
Sorry for the vent/rant. Any suggestions about local surgeons is appreciated.
His prices seemed a little high to me based on some of the numbers I have heard from others in the Central Texas area (even after the 20%).. Plus he wouldn't even attempt to submit to insurance. I understand he doesn't want the hassle of the ins companies - but his whole demeaner just came across kinda slimy to me LOL
Since then, I did my reasearch on my insurance company (Aetna Open Access - Federal emp plan) and they will cover the Panni removal if deemed medically necessary. I printed off their CPBs for Cosmetic Surgery, Abdominoplasty, and Breast Reconstruction. I have the dates that I saw my doctors for rashs (including a recurring NASTY bacterial infection I get in my Belly button that smells like rotting flesh
). I have the xrays of the lump that was removed from my right breast in 2008 (to try to ask for reconstruction).Today I had another consult with one of the PS's recommended by my WLS surgeon. This guy is highly recommended and his brother (in the same practice) did my Breast Reduction way back in '96, so I know their work personnally. Right now he does "mostly" post WLS body countouring with plans to move to only this market soon.
I should have known they wern't going to be "insurance friendly" when the lady I set the appointment with on the phone was very combative when I even mentioned that I wanted the initial visit billed to the insurance (cause my ins comany will allow this - I checked). But I know not to discount the quality of Doctors due to their rude office staff - one of my favorite Dr's has horrendous staff, but she is wonderful.
I got to the office and the staff had already called my insurance and asked if the panni was covered and they were told no. When I explained that it was no- unless medically necessary - they didn't seem to think I knew what I was talking about.
His suggestions were right along with what I already knew I wanted, a full Circumferential Body Lift, breast lift, and he even suggested 'augmenting' my rear (which is something I didn't have even when I was a teenager LOL). He and I both agreed that my arms were very minimal and didn't need to be done and that my inner thighs would smooth out to an acceptable level with the LBL.
He said he saw the note that nothing was covered, but said he understood that I had different info. He said that is was maybe possible to bill the Panni to the insurance and me pay the difference of the rest... and I told him I was cool with that and that was what I had figured i'd have to do.
So he left and I went into the money ladys office. I recognized her voice as Ms Grumpy from setting the appt. She gave me his prices, the LBL seperate ($14K), the BL seperate ($7K) and then a combined price ($21K). She mentioned that he does the procedure alone, I asked if that was normal (since I had heard it was usually a 2-Dr procedure). She, again got offened at my question and said that they could add in an assistant if I wanted, but the price would be significantly higer if they did (additional $3,200). Add to that, his prices were higher that the used-car salemans pre-discount price.
When I asked about the Dr's suggestion about billing the Panni to the insurance she looked at me like I was from Mars.. I told her it was his idea. she kinda flaked out and fumbled around her desk saying that she would have to cal the hospital and ask them how much it would change the price since it would be billed though them. (huh?) I asked if she could even give me a ballpark figure and she said it wasn't possible to do that until contacting the hospital and even finding out if the insurance would cover it.
I know there are other Plastic Surgeons in San Antonio and my WLS surgeon has a couple of others he recommends...
BUT do I have to go through all of this with each Plastic Surgeon after already paying the copay?
Is there a way to get them to let me know IF they are even willing to submit the procedures to the insurance companies and then deal with the results?
I know getting this covered is a crap-shoot, but i'd at least like a Dr that would try.
Sorry for the vent/rant. Any suggestions about local surgeons is appreciated.
RNY - 12/10/2008 Dr. Terive Duperier of BMI of Texas
Lower Body Lift / Breast Lift - 07/20/2011 Dr Peter Fisher of San Antonio Plastic Surgery Center
Lower Body Lift / Breast Lift - 07/20/2011 Dr Peter Fisher of San Antonio Plastic Surgery Center
I'm sorry you went through this. I have to be honest, I've had a total of 6consults and only tow where willling to accept the insurance. Oh I forgot to mention I have a preapproval lettr from the insurance. Now 2 of them would accept it but I would have to pay upfront and then be reimbursed if the insurance paid. another one sounded so shady I just X'd him out all together even though he was willing to take insurance and even let me pay him in payments for my out of pocket maxium. I don't know if you are willing to drive but Dr. Bullock at Baylor is awesome. He is so nice and truely concerned. He was honest about what I cold expect and has e-mailed me back every single time i sent him an e-mail. also baylor works with Insurance. PM me if you like and I have the pricing of several procedures.
What was involved in getting the pre-approval letter from the insurance co?
RNY - 12/10/2008 Dr. Terive Duperier of BMI of Texas
Lower Body Lift / Breast Lift - 07/20/2011 Dr Peter Fisher of San Antonio Plastic Surgery Center
Lower Body Lift / Breast Lift - 07/20/2011 Dr Peter Fisher of San Antonio Plastic Surgery Center
Sending a letter to insurance is not that big a deal. Collecting the records to prove you have prior infections may be more involved, but once I let patients do that part on their own it happened a lot faster. Doc give records to patients a lot faster than when we request them plus they dont get "lost in the shuffle."
Collect your past records documenting infections, and find a surgeon who is willing to do this before you go in. It can save you some money esp. on the hospital and overnight stay.
Best
Collect your past records documenting infections, and find a surgeon who is willing to do this before you go in. It can save you some money esp. on the hospital and overnight stay.
Best
John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas
www.DrLoMonaco.com
www.BodyLiftHouston.com
Plastic Surgery
Houston, Texas
www.DrLoMonaco.com
www.BodyLiftHouston.com
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