I met with my PS five weeks ago and he said I'll very likely be covered (24 years old, 32H, years of neck pain, shoulder grooves, not overweight, migraines, and 2 years of chiropractic care). The PS office was told the deadline for a decision is 5/16. BCBS sent a letter on 5/9 requesting ICD-10 and HCPC/CPT codes. The letter also says that if I've been sent this request, it "may serve as a notice of an adverse determination." I haven't heard otherwise, so is this a denial of coverage?
Answer: Breast Reduction I would call the office of your plastic surgeon and speak with the biller in the office. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with. Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon
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Answer: Breast Reduction I would call the office of your plastic surgeon and speak with the biller in the office. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with. Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon
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May 18, 2017
Answer: Breast Reduction Under Insurance I am not sure if it is. In general all that information is submitted by the office with photos and at times the insurance company may ask for more information. Codes are generally all listed at the time of submission. Therefore, I am not certain what is exactly going on here.I would recommend calling your PS office and discussing what exactly is going on. Usually, the letter that is sent is pretty straight forward on whether the procedure was approved or denied.Hope that helps.
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May 18, 2017
Answer: Breast Reduction Under Insurance I am not sure if it is. In general all that information is submitted by the office with photos and at times the insurance company may ask for more information. Codes are generally all listed at the time of submission. Therefore, I am not certain what is exactly going on here.I would recommend calling your PS office and discussing what exactly is going on. Usually, the letter that is sent is pretty straight forward on whether the procedure was approved or denied.Hope that helps.
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May 17, 2017
Answer: Problems With BCBS TX This is an insurance billing question for your PS's office. I assume you requested that your PS's office send the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnostic code, and Healthcare Common Procedure Coding System (HCPSC)/Current Procedural Terminology (CPR) codes prior to May 16, 2017 to BCBS of Texas. The HCPSS codes represent medical procedures to Medicare, Medicaid, and several other third-party payers. The includes services such as ambulance, durable medical equipment, prosthetics, orthotics and supplies when used outside a physician's office. The CPT is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA
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May 17, 2017
Answer: Problems With BCBS TX This is an insurance billing question for your PS's office. I assume you requested that your PS's office send the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnostic code, and Healthcare Common Procedure Coding System (HCPSC)/Current Procedural Terminology (CPR) codes prior to May 16, 2017 to BCBS of Texas. The HCPSS codes represent medical procedures to Medicare, Medicaid, and several other third-party payers. The includes services such as ambulance, durable medical equipment, prosthetics, orthotics and supplies when used outside a physician's office. The CPT is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA
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May 18, 2017
Answer: Question Regarding BCBS Coverage for Breast Reduction From what you described, there is a very high probability that you will be covered by insurance though this also depends on what your particular plan requires. You need to contact your plastic surgeon's office and see where things are at this point in time. Often, the process for certification for coverage is very time consuming and difficult.Steven Turkeltaub, MD
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May 18, 2017
Answer: Question Regarding BCBS Coverage for Breast Reduction From what you described, there is a very high probability that you will be covered by insurance though this also depends on what your particular plan requires. You need to contact your plastic surgeon's office and see where things are at this point in time. Often, the process for certification for coverage is very time consuming and difficult.Steven Turkeltaub, MD
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May 18, 2017
Answer: Breast Reduction Insurance Coverage Typically Insurances will cover a Breast Reduction procedure, provided you meet their criteria for a patient needing a breast reduction. This typically consists of the items you have listed, as well as your height, weight, and how much breast tissue will be removed.If your case is denied, the insurance company will send you a letter stating this. It sounds like the insurance company has requested additional information and/or codes. If that is the case, they are still processing and haven't made a determination. You can always ask your plastic surgeon's office to check on the status of your authorization, or just call up your insurance company and ask.
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May 18, 2017
Answer: Breast Reduction Insurance Coverage Typically Insurances will cover a Breast Reduction procedure, provided you meet their criteria for a patient needing a breast reduction. This typically consists of the items you have listed, as well as your height, weight, and how much breast tissue will be removed.If your case is denied, the insurance company will send you a letter stating this. It sounds like the insurance company has requested additional information and/or codes. If that is the case, they are still processing and haven't made a determination. You can always ask your plastic surgeon's office to check on the status of your authorization, or just call up your insurance company and ask.
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