Upper & Lower Panniculectomy
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
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
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
Congrats on getting it covered. Anything is surely better than nothing!
Denise
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