Breast Reduction - How Do Insurance Companies Choose Surgeons?
- Asked by janfitz in MA
- 3 years ago
I hope to have a breast reduction, but must use a surgeon associated with my plan. How does insurance company pick physicians?
Most insurance companies "take all comers."
In other words, if the physician is willing to accept the contracted rate of reimbursement that is often 70% lower than their "usual and customary" charges, then it is nearly automatic that the physician will be added to their list of providers.
The assertion that your insurance company only accepts the "top physicians" is nearly always a deceptive statement. In fact, the "top physicians" in plastic surgery are usually too busy to accommodate additional patients who they are required to provide a tremendous discount.
Generally, it is safe to assume that your insurance company is contracting with any physician who is willing to accept the terms of the contract. I would not use that as my sole criteria for assessing the physician's qualifications.
Breast Reduction and Insurance/Physicians?
Thank you for the question.
Generally, insurance companies do not “pick physicians”. Physician apply to be on an insurance companies “panel” and agree to a payment schedule/ contract.
For patients considering breast reduction surgery, selection of the plastic surgeon is a very important decision they will be making. This decision should be made based on the quality of the work the plastic surgery does, not whether he/she is on and insurance companies' panel.
I hope this helps.
Insurance companies and surgeons
Insurance companies do not necessarily pick the surgeons. The surgeonsoften join the plans so that they can get business allowing the insurance companies to pay them very little for their work.
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How do insurance companies select physicians
That is a great question. Typically, a surgeon submits the application to the insurance company with an agreement that they are willing to accept their terms of payments. In some instances, the insurance company will confirm the credientials and claims made in the applciation
Most have administrative standards. You should pick based on your own investigation.
Most insurance companies accept plastic surgeons onto their list or panel of approved providers based on meeting minimal standards of education and training, and that the surgeon is willing to accept the insurance company's discounted rates.
Surgeons, or the management of larger physician groups, make their own decision whether contracting with each insurance company will be worthwhile for them and their patients.
The patients are free to chose among the surgeons listed on their insurance company's panel, or to pay an independent surgeon - if they determine such a surgeon would be better for them. Many surgeons provide breast reduction in accredited office surgical facilities, at rates far less than you would be charged at a hospital contracted with your insurance company.
Several calls to experienced plastic surgeons in your area should help you in your decision. Best of luck.
Breast reduction and insurance companies
Some plastic surgeons are associated with some insurance companies (in-network) and others are not. The insurance companies do not "pick" the plastic surgeons. What is important is that you are comfortable with your plastic surgeon before committing to a breast reduction, regardless of whether they are affiliated with a particular insurance company or not. You should see several before and after photos and be sure your surgeon carefully explains the procedure as well as the risks and benefits.
Web reference: http://www.williambrunomd.com
Plastic surgeons do not work for the insurance companay
Insurance companies do not pick plastic surgeons or any other physician. The patient picks their own insurance carrier. Physicians then agree to the terms of the individual plans. In this manner the plastic surgeon will be listed as an approved provider. As private practitioners of medicine and plastic surgery we work only for our patients using our skill and judgment to give you the best result.
Breast Reduction - How Do Insurance Companies Choose Surgeons
I think you are mis informed. The doctors decide if they wish to join a participating doctor of a certain insurance company. The doctor fills an application out and submits it for review. The insurance company than reviews the doctor and decides if they need or want this doctor. I WAS affiliated with many may insurance companies over the years (30+), there is or are no reasons why one company has a few doctors doing Plastic surgery while another has many. Just find the PLASTIC SURGEONS in your plan see as many as you want to find the one you are comfortable with. Otherwise if you have a certain PS you wish to use and they are not in the insurance plan you have. Than we can see if the doctor will accept the insurance payment as a "out of network" provider.
Breast reduction surgeons choose the insurance company
To be in a particular insurance company plan as a plastic surgery provider, the surgeon must contract to provide medically necessary services at the contracted rate with that company. The insurance company will have a credentialing process which will set standards for their providers, however the contract is essentially about cost. A surgeon will choose to participate with a particular insurance plan only if the reimbursement reflects a fair value for the service provided.
Best of luck,
Web reference: http://www.peterejohnsonmd.com/pages/breast-reduction.html
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.