Upper & Lower Panniculectomy

Metsman6969
on 12/28/11 3:53 am
Hi I had a Upper & Lower Panniculectomy on 12/9. my surgeon sent a pre-certification letter to my Insurance company in November and it was denied (considered cosmetic), I deceided to move forward regardless of insurance approval, the Surgeon required payment upfront so i paid $11,200,000 out of Pocket, on 12/14, the insurance company reversed their decision and approved the procedure, I just spoke to Doctors billing department and they told me to submit the claim myself to the insurance company and have them pay me directty, any thoughts how much of that 11K i paid surgeon i should expect the insurance company to reimburse me

The Procedure codes that were approved were ICD-9 278.1 x 2 (553.20)  & CPT: 15830 X 2, (49560)
 if that helps

Thanks in advance     
waitinggame
on 12/28/11 4:42 am - Bowie, MD
I hope to find out the same thing since I was originally denied and am now looking at my surgeon doing a peer-to-peer review to try to get the decision reversed. Having said that, I don't know about what upper and lower panniculectomy means. I thought there was just one panniculectomy procedure. When I asked about what  could expect to get reimbursed the office gal told me it was a 3600.00 surgeon fee, but it is my belief that I would be reimbursed what I paid for the night in the hospital as well as the or/anestesia time alloted for the panniculectomy portion of all of the procedures I had. I was told I could expect back about 5K total and taking into consideration the other items I mentioned I think that is about right.

Congrats on getting it covered. Anything is surely better than nothing! 

Denise

Check out my blog--menumealplanning.com. Tales of making meal planning managable, family fodder, and everything else under the sun. 

RNY 2/3/09, LBL/BL w/Augmentation 9/16/11
Start weight: 335 Current weight: 185 Goal weight: Whatever the hell I can maintain without driving myself insane


                    ButterflyCenturyCard-5.gif picture by barbccrn

 

*6.5 lost preop

Most Active
×