About a year and a half ago my plastic surgeon submitted my request to insurance and it got approved removing 300g. I didn't go through with it, but when I went back now it had expired. At my consultation a few months ago my plastic surgeon said that she would submit another request. Today I called the insurance office and the woman told me that insurance does not approve any amount to be removed. She said that everything is post op and that they would examine if it was medically necessary then.
Answer: Insurance Coverage Most insurances will do what is call a Pre-Determination for Medical Necessity. It is a process and may take a couple months but it can be done. They won't give you an actual authorization number but they will review your surgeon's notes as well as your primary care and physical therapy notes to determine if surgical intervention is medically necessary. If it is determined that your case is medically necessary then it is typical that they will cover the surgery. With that being said some Plastic Surgeon's will collect payment in full up front and when the insurance pays, you will be reimbursed. All the best to you!
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CONTACT NOW Answer: Insurance Coverage Most insurances will do what is call a Pre-Determination for Medical Necessity. It is a process and may take a couple months but it can be done. They won't give you an actual authorization number but they will review your surgeon's notes as well as your primary care and physical therapy notes to determine if surgical intervention is medically necessary. If it is determined that your case is medically necessary then it is typical that they will cover the surgery. With that being said some Plastic Surgeon's will collect payment in full up front and when the insurance pays, you will be reimbursed. All the best to you!
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CONTACT NOW November 17, 2014
Answer: Blue Cross Blue Shield Your surgeon can contact your insurance company and, almost always, find out in advance if the surgery will be covered. It should be a very straightforward process.
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CONTACT NOW November 17, 2014
Answer: Blue Cross Blue Shield Your surgeon can contact your insurance company and, almost always, find out in advance if the surgery will be covered. It should be a very straightforward process.
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November 11, 2014
Answer: Reduction should be predetermined Thanks for your question. Dealing with approval from any of the insurance companies is frustrating for all parties. In our area we provide documentation and photos along with expected amount to be removed. A letter of predetermination is then issued either denying or approving the surgery. If you personally contact them after this submission it may get expedited. 300gm is a small amount to approve, but that doesn't mean it won't relieve your symptoms. It just means they don't want to pay for it. Best of Luck!
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CONTACT NOW November 11, 2014
Answer: Reduction should be predetermined Thanks for your question. Dealing with approval from any of the insurance companies is frustrating for all parties. In our area we provide documentation and photos along with expected amount to be removed. A letter of predetermination is then issued either denying or approving the surgery. If you personally contact them after this submission it may get expedited. 300gm is a small amount to approve, but that doesn't mean it won't relieve your symptoms. It just means they don't want to pay for it. Best of Luck!
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November 10, 2014
Answer: Under BlueCross BlueSheild Carefirst program, can Breast Reductions not be deemed medically necessary until post op evaluation? Unfortunately, it can be frustrating when dealing with health insurance companies; they are in the position to be able to “change the rules” when it comes to coverage for breast reduction surgery. You may want to double check the information received with another official from the insurance company. When I see patients in consultation for breast reduction surgery, I remind them that this operation is one of the most patient pleasing operations performed; it is worth being patient and persistent when dealing with health insurance companies. Best wishes.
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CONTACT NOW November 10, 2014
Answer: Under BlueCross BlueSheild Carefirst program, can Breast Reductions not be deemed medically necessary until post op evaluation? Unfortunately, it can be frustrating when dealing with health insurance companies; they are in the position to be able to “change the rules” when it comes to coverage for breast reduction surgery. You may want to double check the information received with another official from the insurance company. When I see patients in consultation for breast reduction surgery, I remind them that this operation is one of the most patient pleasing operations performed; it is worth being patient and persistent when dealing with health insurance companies. Best wishes.
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November 11, 2014
Answer: Insurance It sounds like your carrier used to do preauthorizations for breast reduction, but have stopped doing so. Unfortunately, this is their call. My hunch is that the carrier expects fewer women will go through with the procedure were there uncertainty about coverage. I suspect that had they previously decided that the procedure were medically necessary by pre-authorizing the procedure before, they would be hard pressed to say later that it was not.All the best.
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November 11, 2014
Answer: Insurance It sounds like your carrier used to do preauthorizations for breast reduction, but have stopped doing so. Unfortunately, this is their call. My hunch is that the carrier expects fewer women will go through with the procedure were there uncertainty about coverage. I suspect that had they previously decided that the procedure were medically necessary by pre-authorizing the procedure before, they would be hard pressed to say later that it was not.All the best.
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