Plastic surgeon won't bill insurance

I was very excited to schedule a consult after determining that my insurance will pay for panniculectomy abdominoplasty and belt lipectomy.  Imagine my surprise to learn when speaking with the coordinator in plastics office that they only submit to insurance for panniculectomy and anything else must be paid out of pocket?  Why?  I really don't know how to shop for plastics. This was a referral from my bariatric surgeon. Is everyone here paying out of pocket?

Most insurance will only cover the panni, and people upgrade to a tummy tuck or lipectomy on their own nickel.  Doesn't mean that your insurance won't cover more, but it's not the norm.  I suspect your surgeon only puts in paperwork for the panni because that's all that usually gets approved.  Talk to your insurance and find out exactly what they'll cover.

When I offered to send the coordinator my policy she said no. I mean really???  She was surprised that I was so knowledgeable about the different procedures. Thanks OH :)

I had the same issue when looking around for a surgeon. My insurance would cover the abdominoplasty, not just the panniculectomy. Some doctors would not believe I was correct, and others flat out said even if I had insurance coverage for anything other than a pannic, they would not accept it and I would have to pay out of pocket. One doctor told me that her usual surgeon's fee for a tummy tuck is $4000, but if she goes through insurance, they pay her $800. It's the way the health care system here works, and doctors do not receive any where near as much compensation for their time if they go through insurance, in addition to the extra hassle of dealing with insurance companies to begin with. It's not really fair to anyone, but it is what it is right now. Keep looking, although it is a pain! I wound up finding a doctor that took the insurance payment for a pannic and did the extra work for a tummy tuck at no charge, and then I paid the difference for the remaining work for the lower body lift. In all it cost me a little less than $8K. Still pricey, but I had a few minor complications, and it was nice to know that those were covered by insurance. If not, I would of had to pay a lot more. Good luck!

Thanks for the info. It's good to hear there is room for negotiation. Congrats!

We try and submit for any and all procedures after bariatric surgery. The reimbursements sometimes are quite low and maybe that is why the office did not want to submit. Also,unfortunately, many of the bariatric surgeons require that for that referral to "their"  plastic surgeon, there is a fee/percentage paid back!

Wow it sounds like everyone gets a piece of the pie. Thanks for the info. I have never negotiated with a doctor before. It looks like I am going to have to "haggle".  Any tips 

Another interesting thing to consider, is that some doctors are willing to offer a "cash discount". So if you save up for the surgery to pay in cash, they'd give you a discount since they aren't paying credit card fees and getting their cash flow immediately.

Thanks for the cash info. I have my initial consult next week. So if surgeon will submit to insurance for pannus is eligible for insurance I can pay for additional work out of pocket which may result in additional discounts.   

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Most plastic surgeons as well as hospitals/outpatient centers will offer a discount when insurance doesn't have to be billed for with the latter, the reimbursement or payment from the insurance company is always in jeopardy for sometimes, even after an approval for a procedure, the insurance company after the surgery is done may deny the claim. Then the patient ends up being responsible for the fees and the hospital and doctor don't get their fees. That is why you do need a strong plastic surgeon advocate to help you get through this process.