Plastic Surgery and Insurance Bologna. Any and all advice appreciated!

A few days ago I got a call from the plastic surgeon's office that my insurance refuses to cover the excision of any skin. There is a plan exclusion for the removal of any skin.

My plastic surgeon's office just called me back. My insurance refuses to cover any skin excision. So, the plastic surgeon submitted a claim for approval to remove my hidradenitis (i have a skin disease called hidradenitis suppurativa which effects areas of skin with sweat glands or inside skin folds). My hidradenitis is in all the areas where I have excess skin. So, my insurance WILL cover the excision of the skin affected with hidradenitis, but nothing else. The plastic surgeon said that they would give me a quote for the rest of the procedure which I would pay out of pocket. She tells me that I will still have to pay out of pocket for a portion of the anesthesia cost for the portion of the procedure that is "cosmetic". This also applies to the surgical room, surgeon fee, etc. Now, I thought, since my insurance is covering the removal of my hidradenitis, why should I pay out of pocket for anesthesia, OR time, etc. etc?? Any and all thoughts on this would be most helpful!

Oh, by the way, I want a LBL, or at the very least, a TT

Not to sound too cynical but I am being honest.
Bureaucracy sucks everywhere. I understand your problem and concern and hope it gets resolved soon and only to your benefit!
I got my Abdominoplasty after appeal and hoping for a Boob job and complete coverage by my HMO but I still have a medical review and am waiting for date for surgery and mo guarantee for anything.
Mikimi in Israel

I believe that you are being told that your insurance will cover what it does ..and the associated anesthesia.
Then, your ps is going to do additional work that you will pay extra for.
You will also have to pay extra for the added surgery and anesthesia time for the additional work.

When I had my band, they found a hiatal hernia .... The band surgeon fixed it for free, but I was billed later on for an extra 15 minutes of anesthesia and surgical suite time.

They track procedures by the minute ... And bill you or your insurance company by the minute.

I believe that you are being told that your insurance will cover what it does ..and the associated anesthesia.
Then, your ps is going to do additional work that you will pay extra for.
You will also have to pay extra for the added surgery and anesthesia time for the additional work.

When I had my band, they found a hiatal hernia .... The band surgeon fixed it for free, but I was billed later on for an extra 15 minutes of anesthesia and surgical suite time.

They track procedures by the minute ... And bill you or your insurance company by the minute.

 When u pay for the or room and anesthesia, you pay by the time.  My surgeon booked everything for a certain amt of time and that is what I paid.  The insurance is willing to pay for the time needed on the things they will cover but not the rest.  I think u should consider yourself lucky that they r willing to cover some of the cost.  Hope it works out for u.

Patty

This has been my experience too...INS wants to know how much time will be devoted to the covered procedure, and how much time is for non-covered.  

Your  surgeon, hospital, and anesthesia services are entitled to bill for work they do that will not be paid by INS.

My preference is to agree on the fees BEFORE surgery so no surpise billing of some horrendous amount happens after surgery.  Both my hospital and anesthesia team are very good about doing this, and patients appreciate knowing how to plan accordingly.