Will Insurance Cover Revisional Unilateral Otoplasty 15 Years Ago?

I am 39. Had bilateral OTOPLASTY performed over 15 years ago. Within last year the stitches have undone themself onanterior portion of ear lobe +2 cms. My question is will my insurance (Anthem BCBS) cover the revisional surgery?? Any ideas on how I can get Dr. to write letter to insurance with proper CPT coding and wording to pay for surgery due to the stitches undoing/? I am a R.N. and need ANY advice/ideas PLEASE!!! TY

Doctor Answers (6)

Insurance for ears

+1

Whether it gets paid for by insurance will spend upon how the surgeon chooses to code the procedure.  I am always honest with the insurance companies and in your case, it is truly a consequence of previous cosmetic surgery.  Therefore, I doubt that your insurance will cover the procedure at all, but your never know.


San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Insurance coverage for otoplasty revision with ear sutures becoming undone

+1

With surgery 15 years ago, you otoplasty results really should not be dependent on the sutures. The tissue growing around the surgical wound | area should really be doing all the healing. Unless there is a complication or something, I think it would be hard to cover it under insurance. The cpt coding and wording could be interpreted as insurance fraud so I would be really careful and avoid wording it to be safe!

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 37 reviews

Will Insurance Cover Revisional Unilateral Otoplasty?

+1

Your insurance company will want to know what the medical necessity would be for having a revision surgery.  Since there is no medical necessity, they would not consider  paying.

It is not a matter of using a magic code.  They will want to review the operative note after the surgery and would deny the claim.

 

John F. Reinisch, MD
Beverly Hills Plastic Surgeon

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Will Insurance Cover Revisional Unilateral Otoplasty 15 Years Ago?

+1

Unfortunately, I am not aware of any insurance carriers that cover first-time otoplasty. I would anticipate that they would also deny coverage of an otoplasty revision. The best way to find out is to schedule a consult with a plastic surgeon you trust and have them try to submit the revision for authorization. However, there is a very slim chance that Anthem BCBS will choose to cover the procedure. I hope this information is helpful.

Stephen Weber MD, FACS

Lone Tree Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

Will Insurance Cover Revisional Unilateral Otoplasty 15 Years Ago?

+1

       The procedure was cosmetic in nature at the time of the first surgery, and this revision will be considered cosmetic as well.

 

 

 

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 218 reviews

Otoplasty is cosmetic surgery

+1

 An otoplasty is considered cosmetic surgery and is not billed to the patient's insurance. There is no medical necessity indicated for otoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

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.