I had a bilateral mastectomy with tissue expanders this fall. When I asked my plastic surgeon's office manager how much my out-of-pocket cost would be, she replied, "We'll work with your insurance." Now, months later, the billing department is threatening to charge me $25,000 (this is just the surgeon's fee) for the implant exchange surgery because my insurance only paid $10,000 of the $35,000 they submitted. And the initial tissue expanders submission was for $67,000 for which only $11,000.
What is the Typical Surgeon's Fee for Immediate Reconstruction with Tissue Expanders?
Doctor Answers 5
Unpaid fees for immediate reconstruction with tissue expanders
Thank you for your questions. There is not set fee for reconstruction with tissue expanders. What portion of the bill you are responsible for depends on many things....whether the procedure was a covered benefit under your specific plan, whether your surgeon/hospital was in-Network or out-of-Network, whether you had met your deductible, etc....
I suggest you speak with the physician's office and hospital directly. Also consider the advice of legal counsel, financial counselor, etc... In many instances, a payment plan can be worked out.
Having the charges spelled out on paper in advance helps along with excellent communication on the part of the doctor/hospital and the patient. These situations should and can be avoided.
I hope this helps and that your situation improves. Best wishes.
Breast Reconstruction Costs
If your surgeon is out-of-network, then they have the right to charge you the difference from what your insurance carrier did not cover. If they are in-network, then they cannot charge you anymore then your insurance company says that they can. It does not matter what the office says if they are in-network with your insurance company. In that instance, they can only charge you what the insurance company deems that they can. I would discuss this with your insurance company first before anything so that you know where the costs are coming from, etc. You may also look to find a surgeon in your insurance network if your current surgeon is not. The costs that you are describing sound like they are just trying to get as much moeny as they can from you. A surgeon's fee of $25,000 simply for exchanging the implants is grossly excessive. I hope this helps.
Fees for breast reconstruction
Sorry about your problem, but questions regarding fees shoudl have been discussed up front inlcuding yoru responsibilty and the approximate cost. Discuss this with the doctor's office.
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Insurance and Financial Disagreements in Plastic Surgery
There is no one set price applicable across this country for any surgical procedure. As a rule, the larger and more expensive the city, EVERYTHING there becomes expensive (parking rates, restaurants, all services, contractors and medical charges). Sincde it is very expensived for a Plastic surgeon to have an office in New York (insurance, rent, high cost of staffing, taxes etc) these costs are passed on to the patients just as every other business would do.
Plastic surgeons EITHER accept in full whatever your insurance paid them (after you paid your co-pay and deductible) OR do not work with insurance companies at all. Owing to the often extremely poor reimbursement by NY insurers, many Plastic surgeons do NOT accept insurance. Instead, they are paid by you and havde you get reimbursed whatever your insurance thinks the operation or treatment is worth. It sounds as if you worked under one of these scenarios. If this was the case, every medical office usually tells the patients BEFORE treatment is rendered
- how much the treatment is projected to cost
- when and how much of this sum needs to be paid
- what role, if any, would the patient's insuranced play in any of this
Acceptance of these terms forms a financial understanding and a contractual work agreement between you and the doctor's office much the samer way as it would be with a lawyer or contractor. Neither side can cry foul after the fact and change the terms.
Look at ALL your paperwork, especially anything with the word FINANCIAL which required your signature. If you agreed to be billed for anything the insurance did not pay (and the doctor is NOT an insurance "provider") you do not have much recourse, in my opinion. On the other hand, if you did not agree to such terms OR your surgeon IS working for that insurer, he is NOT allowed to balance bill you and you have the right to be angry and may have legal recourse with the insurance company, the NY insurance commissioner and even the licensing board.
Breast reconstruction cost
There is no typical fee as you can find widely different ranges. Medicare, HMO's, and insurance plans have their own fees determined by political and business factors. Individual surgeons have their own fees determined by market forces, reputation, and experience. The fee should be discussed upfront and specifically. "Working with your insurance plan" is not very clear or legally binding I would guess, but the paperwork and consent you signed might be. i would suggest speaking directly to your surgeon with your concerns as most reputable surgeons working with breast cancer patients will not want to put their patients in financially jeopardy. I had a number of patients who owed tens of thousands of dollars pay me a couple of hundred dollars per months for years so as not to put a burden on them.
Robin T.W. Yuan, M.D.