Plastic surgeon won't bill insurance

I have had several surgical procedures in the past several years that were covered by insurance and have reviewed the 'eob' sent by the insurance company.  To be honest, I am amazed at how little some of these very highly trained doctors are paid for their services.  Usually there is a facility fee that goes along with the procedure so I guess that is where the hospital makes up the slice in surgical fees.  Since most insurance does not pay for plastics, many of those surgeons don't want the hassle of even attempting to get approval if you are just going to walk away if not approved.  I started out with a procedure that was covered and my surgeon gladly took it but we were already talking about other procedures that we both understood would be out of pocket.  We never chatted about whether he would have done the first without knowing the others were coming.  I believe if you are working with a doctor the is affiliated with a major hospital rather than one just with privileges or a surgical center, you have a better chance.  Those docs tend to have the staff and skills needed to deal with the insurance companies.  Just my thoughts on the topic.

Even when I needed my panniculectomy, there literally was not a single plastic surgeon in my city who would bill insurance for it!  They had all banded together and decided to call it cosmetic (even when, by the insurance company criteria it WAS medically necessary... Mine hung down onto my thighs and caused rash issues like crazy)!  They wanted the full self-pay cost rather than the insurance reimbursement amount!

I contacted Aetna (the insurance company I had at the time) and they basically said that you cannot force a surgeon to perform a procedure and bill insurance (even if they are on the PPO's contract and it is a covered procedure).  Since other types of plastic surgery are NOT covered by insurance, it doesn't surprise me that the surgeon is telling you that everything ELSE is considered cosmetic, because that is how the insurance company views it.  

The surgeon knows that insurance won't pay anything so it isn't worth the time and hassle of submitting it and having it denied, and then having to go through the time and hassle of collecting a large amount of money from the patient!  If I are a surgeon, I would do the same thing.

So, yes, most of us are paying out of pocket for our plastic surgeries.

Lora

.

I paid out of pocket because my surgeon's surgical coordinator told me he did not accept insurance. I found out much later, a few weeks before my second stage surgery that he did. So now after the fact, I am trying to get some reimbursement from my health plan. Ugh.

My coordinator for vsg was not very helpful. She kept telling me vsg wasn't covered even after I mailed her my policy three separate times.   Long story short I received my vsg and had to pay $500 deductible.  We have to be empowered and informed.  

Agree with you completely this is not over. 

Lora was simply saying that losing less than 90 pounds should not result in massive amounts of excess skin.  I lose 80 pounds and my abdomen was stretched out and hung down about four inches. 

It was easy to hide in clothes or with shapewear.  I just wanted the nice tight and flat stomach that comes with abdominoplasty.  The excess skin removed weighed about two pounds. 

People who start at 600 pounds and lose more than 400 pounds are the ones that might have 50 pounds of excess skin removed.

Again please don't tell me I don't have skin or a large belly. I have read the qualifications for my insurance.  Pannis hangs below symphysis pubis from the side and front. Trust me I qualify. I'm not sure why this is a sticking point with the other poster or why you feel the need to restate what she said. FYI I have lost more than 90. My sig has not been updated. 

My insurance is covering skin removal from my thighs.  It is excision only, and not a "lift" or thighplasty per se. 

It is a medical necessity, and that's the only reason my insurance is paying.

Some insurances will pay for "lifts" under medical necessity, if that's the only way to accomplish removal of the excess skin, but mine won't. 

Really it's OK with me - I just wanted the flapping to stop, and after my surgery on Friday (5/16/14), that will be accomplished.

I would rather do most of the contouring through muscle building anyway, once I'm healed.