Insurance Trouble - Now what do I do.
I had a consult for abdominplast in February. My insurance paid the entire $340 for the consult. My surgeon submitted everything to insurance for authorization. He include documentation from my physicians regarding rashes and infections as well as the pictures which were taken at the consult. I even had a rash at the time of the consult which was also documented in the pictures.
Today the surgeons office called to tell me that my insurance says I don't need pre-certification. Huh? It seems that my plan, an indemnity/wrap around empire bc/bs does not require pre-certification and does not review cases prior to surgery.
They say I should have the surgery (the surgeon should know if I meet the criteria for medically necessary surgery) and then the surgeron should submit all the documentation with his claim.
Anyone have any experience like this? I have no idea what to do now.
/ilene
Today the surgeons office called to tell me that my insurance says I don't need pre-certification. Huh? It seems that my plan, an indemnity/wrap around empire bc/bs does not require pre-certification and does not review cases prior to surgery.
They say I should have the surgery (the surgeon should know if I meet the criteria for medically necessary surgery) and then the surgeron should submit all the documentation with his claim.
Anyone have any experience like this? I have no idea what to do now.
/ilene
Word to the wise: You will need to be prepared to pay the cosmetic price for this procedure, and get an estimate of the costs beforehand so you'd be prepared to handle it should this be considered a non-covered benefit after the surgery. If your pannus is not a slam-dunk one of those down below mid thigh or with raging paniculitis, you do run a very real risk of ultimately having to pay out of pocket at the end of the day.
on the web at Plastic Surgery Specialists
blogging on all things plastic surgery at Plastic Surgery 101
blogging on all things plastic surgery at Plastic Surgery 101