Health Insurance, Predestination and Plastic Surgery

2:24 AM RAWAT 0 Comments

Third party insurance and potential coverage for surgical procedures are an important part of your overall health care program. Many plastic surgeons are happy to participate and help you maximize your insurance benefits.

Plastic surgeons work with many insurance companies daily and are well acquainted with this process. It is important that you understand how this process works and that you are provided with the following information.

After your plastic surgeon sees and evaluates and determines that your problem can be covered by your health insurance, a detailed process follows to determine your eligibility and benefits available through your surgeon insurance provider.

In most surgical procedures of a non-urgent nature, the proposed surgical intervention must be predefined.

It consists of a written letter from your plastic surgeon describing the medical problem, the proposed operation, photographs and documentation (if applicable) of the symptoms associated with the medical problem. No elective plastic surgery procedure today can be approved by a simple phone call.

When will my preliminary decision be sent?

At a minimum, it takes 1 to 2 days to collect all the medical information and put it in the appropriate format for sending to the insurance company. This time may take longer if there is an expectation on the supporting documents of other doctors, copies of tests, etc.

The final letter will not be sent until all information has been received. Submitting an incomplete preliminary determination will only result in an immediate denial of coverage and a much longer delay to start the process again.

How long does it take to get an answer from my insurance company?

It usually takes between 6 and 8 weeks to get a formal written response from your insurance provider. Usually you get a letter from your insurance company before a plastic surgeon.

Since you are a subscriber, they often send you a decision letter and copy the second plastic surgeon as a provider. Therefore, if you did not hear from the insurance company, your plastic surgeon did not hear either.

If you want to try to speed up the process, it is important that you contact your insurance provider and not the plastic surgeon’s office. They can do nothing to expedite the predestination process through an insurance company. Only the subscriber who pays the fees can expedite this process if he does.

What happens if an insurance company refuses my procedure?

Unfortunately, some plastic surgeries, although medically necessary, are prohibited. The reasons for this refusal are described in detail in the insurance letter that you receive with this decision. If this happens, your plastic surgeon will work with you to try and make the final favorable decision.

Sometimes this requires only additional documentation about the state of health, but often the refusal is based on your determination that this is done only for cosmetic benefit.