Why surgeons do not accept insurance & help patients get rid of recalled implants?

Question

A lot of health insurance are now covering the removal of allergan biocell implants amongst other textured implants regardless if the initial implant was placed solely for cosmetic purpose. Why would a surgeon not want to help a patient get rid of the recalled implants or at least write a pre authorization for the insurance since it does deem it a medicall necessity due to the risk of getting BIA-ALCL? I’ve called maybe 8 surgeons in which their offices simply decline any help claim yourself.

Camille Cash, MD · Answer

In general plastic surgeons are very interested in helping patients safely achieve their aesthetic goals.  Working with insurance companies is not as simple as a surgeon accepting a certain type of insurance.  There is a process that goes on behind the scenes involving agreements between the two parties for what each has to do and the agreed upon fee for services.  Depending on the insurance company this can be a cumbersome process.  However many plastic surgeons will work with certain companies that finance medical procedures in order to assist patients with their needs.

Shaher W. Khan, MD · Answer

Hello, thank you for your question. The situation you're describing involves a combination of factors that may explain why many surgeons are reluctant to assist with the removal of recalled implants or to support insurance pre-authorization for these procedures. Please see the video attached that answers your question in detail. The reluctance of surgeons to help with the removal of recalled implants or write pre-authorization for insurance may stem from administrative, financial, and logistical reasons. However, it’s important for patients to be persistent and seek out surgeons who specialize in breast implant revisions or reconstructive surgery. Additionally, it might help to work with a medical professional who is well-versed in navigating insurance claims for situations involving health risks related to implants. If you’re finding it difficult to get the support you need, consider seeking advice from patient advocacy groups or organizations specializing in implant safety. They may be able to provide recommendations for surgeons who are more open to helping with these kinds of medical issues.

Richard Baxter, MD · Answer

A few things to be aware of: First, the recall on Allergan Biocell implants is not a recommendation that they be removed, so it is not a medical necessity most of the time; and second, many plastic surgeons specializing in aesthetic surgery do not contract with insurance companies for a variety of reasons, and insurers may not allow you to use out of network doctors.

Connie Hiers, MD, FACS · Answer

Many surgeons, including myself, no longer accept insurance nor are in network with these companies because of previous hassles of dealing with insurance. Also, many of us only do cosmetic surgeries which are not covered by insurance. One surgeon not in network will not be accepted or reimbursed by insurance companies.

Douglas Taranow, DO, FACOS · Answer

I cannot answer for other surgeons, but from experience, there are several issues.  
First, not participating in most insurance programs, I would not be paid.  
Second, although the insurance carrier pre-approves your procedure, they are not obligated to pay the surgeon!  This has happened countless times where they find reasons why it is not covered.  Lastly, I have waited upwards of one year (YES, ONE FULL YEAR) for a reimbursement check to arrive.
The time and effort sending out multiple duplicate operative reports etcetera are mentally taxing.  
I agree surgeons should be more compassionate, I can only guess why you are having such difficulties.
Best wishes in having your procedure performed and an uneventful recovery.

Why surgeons do not accept insurance & help patients get rid of recalled implants?

Answers (5)

Answer: Insurance

Answer: Insurance

Answer: Insurance coverage for explantation

Answer: Insurance coverage for explantation

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Why surgeons do not accept insurance & help patients get rid of recalled implants?

Answers (5)

Answer: Insurance

Answer: Insurance

Answer: Insurance coverage for explantation

Answer: Insurance coverage for explantation

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.