How to get insurance to cover!

[NLeary]

I just wanted to tell everyone that I will be haveing my surgury in 6 days and I got insurance to cover it!!! I have insurance through work, BlueCross BlueShield of Georgia. (I live in NC though). If you look on their website and you go to the section for healthcare providers and find where you can search for a procedure by name or CPT#19140 (thats the billing code for the surgery), then it will bring up the insurance company's policy for the procedure. This is used to tell the doctor how much he will get out of them, or how much I would have to pay... And the neccessary steps to get insurance to cover it. Well It outlined the steps such as going to my endocrinologist to see if it was hormonal, he said no, and it states that it can't be only from overweight (must be actual breast tissue). and stipulates a few other things as well. Not really a hard thing, only its kinda time consuming cuz the endocrinologist had to run a bunch of test and it wook about 2 weeks to get the results. Oh and the surgeon had to submit photos when he sent in the pre-cert. request. It took the insurance company about 5 weeks to process it but they approved it!!!!! With my plan I have a $500 deductable, which I already met about $250 of that from the endocrinologist, and then after that they cover 80% of the entire thing, BUT, after I've paid $1000 out of pocket expense (after the deductable has reached) then they cover 100%!!! So I had to pay the rest of the deductable and the $1000 (about $1250 if you don't wanna do the math) then everything else if covered! Thats the Surgeon's fee, the anesthesiologist and the facility fees and I think they plan to do a pathology report on it as well. Which is great cuz My surgeon uses the hospital for the facility and for this procedure, would cost almost $22,000! just for the facility (covers nurses etc. too) then the surgeon's fee is about $3900, and then whatever the anesthesiologist charges! I dont' know why the facility fee is so outrageous though... I had a quote from another surgeon who did it in his own facility and the total (with the anesthesiologist and surgeon's fee) was about $4800. I guess cuz its a hospital... the women getting the insurance info from me said it surprised her too, but she said if it was just a masectomy then the facility fee would only be about $8500, but since it is reconstructive too, then it jumps up... But like I said, I'm paying a total out of my pocket of only about $1250! I consider that to be a hell of a lot cheaper then having to pay for it all myself!

I guess I'm just trying to say, just because you have to go through pre-certification for insurance to cover it, don't give up hope, the insurance companies really aren't so negative... I wish I had a cam to put up some before pics so you can see how mild my case is. It is noticeable though, and it is glandular, and because I followed the steps set by the insurance company, I have been approved! The worst part is waiting... Start to finish, I'd say the shortest possible time to go through the neccessary steps to get approved would be about 3 months or so, depending on how far out appointments are with you different doctors and the surgeon... I was lucky when It came to the surgeon, after I was approved the surgury date was set only about 2 1/2 weeks out (other surgeons are 2-3 months)!

[Paa_Paw]

Congratulations!

It sounds like you did all the needed homework, went through all the needed steps, and you are now ready for surgery with a very good chance of success.

Often, people want to take shortcuts and they are then not happy with the result.

A couple of old axioms:

Anything well worth doing is worth doing well.

If we don't have time to do it right, will we have time to do it over?

[Preds]

I just wanted to tell everyone that I will be haveing my surgury in 6 days and I got insurance to cover it!!! I have insurance through work, BlueCross BlueShield of Georgia. (I live in NC though). If you look on their website and you go to the section for healthcare providers and find where you can search for a procedure by name or CPT#19140 (thats the billing code for the surgery), then it will bring up the insurance company's policy for the procedure. This is used to tell the doctor how much he will get out of them, or how much I would have to pay... And the neccessary steps to get insurance to cover it. Well It outlined the steps such as going to my endocrinologist to see if it was hormonal, he said no, and it states that it can't be only from overweight (must be actual breast tissue). and stipulates a few other things as well. Not really a hard thing, only its kinda time consuming cuz the endocrinologist had to run a bunch of test and it wook about 2 weeks to get the results. Oh and the surgeon had to submit photos when he sent in the pre-cert. request. It took the insurance company about 5 weeks to process it but they approved it!!!!! With my plan I have a $500 deductable, which I already met about $250 of that from the endocrinologist, and then after that they cover 80% of the entire thing, BUT, after I've paid $1000 out of pocket expense (after the deductable has reached) then they cover 100%!!! So I had to pay the rest of the deductable and the $1000 (about $1250 if you don't wanna do the math) then everything else if covered! Thats the Surgeon's fee, the anesthesiologist and the facility fees and I think they plan to do a pathology report on it as well. Which is great cuz My surgeon uses the hospital for the facility and for this procedure, would cost almost $22,000! just for the facility (covers nurses etc. too) then the surgeon's fee is about $3900, and then whatever the anesthesiologist charges! I dont' know why the facility fee is so outrageous though... I had a quote from another surgeon who did it in his own facility and the total (with the anesthesiologist and surgeon's fee) was about $4800. I guess cuz its a hospital... the women getting the insurance info from me said it surprised her too, but she said if it was just a masectomy then the facility fee would only be about $8500, but since it is reconstructive too, then it jumps up... But like I said, I'm paying a total out of my pocket of only about $1250! I consider that to be a hell of a lot cheaper then having to pay for it all myself!

I guess I'm just trying to say, just because you have to go through pre-certification for insurance to cover it, don't give up hope, the insurance companies really aren't so negative... I wish I had a cam to put up some before pics so you can see how mild my case is. It is noticeable though, and it is glandular, and because I followed the steps set by the insurance company, I have been approved! The worst part is waiting... Start to finish, I'd say the shortest possible time to go through the neccessary steps to get approved would be about 3 months or so, depending on how far out appointments are with you different doctors and the surgeon... I was lucky when It came to the surgeon, after I was approved the surgury date was set only about 2 1/2 weeks out (other surgeons are 2-3 months)!

Those numbers seem outragous.  I just had surgery in Atlanta and surgeon fee $2500.  Facility $750.  All total was around $4800
Either someone is sticking it to insurance company or your decima is in wrong place.  lol

[NLeary]

Yeah, I placed my decimals correctly. lol. It is outrageous. Like I said one surgeon quoted me about $4800 too, and I know that the price can vary between different places in the country, I think they are sticking it to the insurance company too lol.

[NorCALSpeed]

I have bluecross blueshield as well, in california. Its on my dads company and hes a doc so i get like 90% of claims covered. Anyway, is that code u gave the code for the procedure all over the US or just through bluecross or ? Just wanna start researching this so that if i can get insurance to cover 90% ill gladly pay the 600 bucks. I think my parents will be more supportive if do the legwork and pay the deductible myself. feel free to pm me with more details, im kind of confused on what an endocrinologist is and such. thanks a lot.