Question:
My dr will not submit doing the arms to my insurance.

My dr will not submit doing the arms to my insurance but the insurance said they would pay for them. My insurace pays 100%. How do I get them to summit or do I need to find another dr that will. The dr said they never submit the arms cause they do it for 600.00 for the people that had wls. What do I do? I like this dr.    — Karen T. (posted on March 16, 2003)

March 16, 2003
Just as in any other medical specialty, there are great plastic surgeons, and there are not-so-great plastic surgeons. The bottom line however, is that there are usually several to choose from. I always suggest that patients get at least two consultations/opinions for any surgery. That is the only way to compare fees, types of incisions, post-op care, etc... It wouldn't hurt to let this particular surgeon know that you will need to consult another surgeon if he feels that he is unable or unwilling to submit the necessary documentation to your insurance provider for the brachioplasty. My own plastic surgeon was completely cooperative in requesting insurance coverage for my brachioplasty, but felt certain that it would be denied since he had never received insurance approval for this procedure in the past. We were both very pleasantly surprised when both my primary and secondary providers approved. Don't give up! :-)
   — Diana T.

March 16, 2003
I agree with the last poster that perhaps you should shop around. You may be pleasantly suprised that you find another doctor who will submit your insurance claim and that you like even better; however if you don't, I have a possible solution. If you really feel comfortable with this Dr. then ask him if you payed the $600.00 upfront if he would give you the claim to file on your own and get a refund. Keeping in mind ofcourse, that the insurance company typically doesn't pay as much as the Dr. charges but if he's going to do the whole procedure for $600.00 they just might. Just a suggestion. Hope this helps and good luck!
   — denisel

March 16, 2003
Six-hundred dollars? Two things I'd do....one is find another plastic surgeon who will bill the insurance company (especially if you know that they will pay for it)....secondly, I'd be sure and get some references......here in Michigan, brachioplasty (arm-lift) by itselt costs between $3,500 and $6,000. Anesthesia alone would be $1,000.....just be sure he's on the up-and-up. Good luck to you!
   — Lynette B.

March 16, 2003
What type of insurance do you have? If the doctor is under contract with your carrier such as a PPO - your insurance company could intervene and get him to 'file'. But I guess what it comes down to is... IF you like this doctor, and DONT want to change... (If he doesnt insist for 'up front' just have him give you an itemized bill, after surgery, and YOU submit to your carrier.. and then reimburse the doctor.. BE sure tho, if this has to be 'pre approved' etc, that you get that done first. Some PS office' do not 'like' to do paper work; if you know your insurance will pay... just ask them to give you all the paper work and let you submit... and do the work... then have the surgery.
   — star .