Submit claim to insurance AFTER surgery??

[outside*looking*in 0]

So - I had my surgery on 2/3 and the doc found and had to repair a hernia. My husband decided to call the insurance to see if they would pick up any of the tab because of the hernia. Their response was "maybe" it depends on how the doc wrote his clinical notes?? So, I have to have the insurance person at the surgeons office submit the notes for a claim. I will keep my fingers crossed my not get my hopes up. We paid a total of about $18,000 for the surgery.

[finallyncontrol 1]

I am in the process of submitting my to the insurance company as well. Got my fingers crossed! They haven't denied it yet! My dr told me that he has seen others get reimbursed..for the hospital charges, anes, lab work..just not his fee. I'll take any reimbursement they will give me!!! Anything is better than nothing..not to be greedy!

[outside*looking*in 0]

I agree, anything is better than nothing! Still waiting to here back from docs office.

[finding me 1]

After reading this I asked my doctors office if they have to fix a hernia and they bill that to the insurance how much would it change my cost....they said nothing I would still be responsible for the whole 16,500. That amount covers everything for the first year plus surgery.

[outside*looking*in 0]

Yes but....I have already paid my docs office the full amount and I am hoping that the insurance will re-emburse some directly to me. That is what the insurance told my husband. It all depends in what his operative notes say???? I will be calling the docs office back tomorrow for more info. I have been waiting since last Wednesday. The thing is, I figure they give you the "discount" rate for the surgery and if they could have billed the insurance it would have probably been much higher. If all else fails you can ask for your operative notes (or whatever your ins requires) and file the claim yourself with the ins.

[finding me 1]

That is a good point. I will have to remember that. I have to pay for all of my surgery up front as well so it makes sense that they would have to refund me the money. Although I guess the office could also bill the insurance for that portrion of the surgery or charge you extra. Hmmmm.....well please keep us informed on what you find out.

[outside*looking*in 0]

Update - so I spoke with the ladies from the office today and it just seems that they have never heard of this before and are not sure what to do. As a self-pay, they have a "package price" basically and don't have an itemized billing. I explained to them that had this hernia been detected BEFORE the surgery there are things that they would have covered. They thought that I was trying to get the ins to cover the whole thing. I explained that I knew they would not cover the band and other things but possibly the anestheia or hospital stay. SO they finally decided to submit the claim today but made sure to let me know that I may be subject to the co-pay??? Ugh, I have paid near $18,000. If they re-imburse some, I will take it out of that. This is still a big ????IF they pay anything. THey may not. I guess we will wait and see. It seems like the docs office is not to enthused about doing this.

[XxMariposaxX 1]

I'm a self-pay patient as well. I didn't go through insurance because WLS is not a covered benefit but if I did they would've paid for everything EXCEPT the doctor's fees if I had to have a hernia repaired.

[finallyncontrol 1]

Outside--from what I am learning from my insurance company..it is best that you do have the doctor's office file the claim. As I have mentioned before I am self pay also trying to see if they will reimburse me for anything. So far thier (the ins co) biggest complaint is "why wouldn't the Dr file his own claim?" Also, the Dr, the hosp and the anes all three gave me three different claims...so I don't think I would have gotten them all to file thier own. I have my fingers crossed..no rejection yet but I am not expecting anything either.

[jtreece 0]

I was self-pay and had a large hiatal hernia. I was able to get my insurance company to pay for the hospital stay because they hadn't processed that claim yet so I had the surgeon and hospital submit the surgical report and change the order of the billing codes. However wasn't able to get them to change the surgery or anethesia denial. They also wouldn't pay for the band which was $3,600. In the end, i did save over $7,300 dollars and they did pay for all my pre-op testing.

[outside*looking*in 0]

It is funny this post just came up as I just got off the phone with the doctors. They are reluctant to submit it for some reason and I don't understand why? This has been such an unneeded hassle that I wonder if it is worth it. Will keep you posted!

[azarellanos 8]

My employer believes in the lap band and provides a "benefit" not insurance for lap band. It is a one time, lifetime, 10,000 and very easy to qualify for. There are a couple of doctors, in Mexico, who work closely with my employer. But I had real reservations about going to Mexico-(since I grew up in a border town) I had my band done in Phx. The drs office said if they had to bill anyone I would be charged the "insurance" rate beginning at 22000. I ended up paying cash price 12500 for my surgery but expect to get 10000 back. Just to be sure I had my pre-certification completed prior to surgery. I'm happy with only 2500 out of pocket. My aftercare, fills etc, are included for 1yr.

Somewhere I heard, cash payers could deduct this on taxes as a medical expense. anyone else heard that?

[finallyncontrol 1]

Yes, you can claim all of your medical expenses for the year on your taxes..in your case you can only claim the 2500 since you were reimbursed 10k..so 2500 plus any and all other medical bills that you have incurred for this year (prescriptions, office visits and so forth). I am not a tax expert, I just know how my tax accountant did my taxes. You can google taxes and medical bills..you can get the legal definitions or if you use quicken it will ask you all the right questions.

I hope this helps..

[lakeside 1]

I was self pay and also submitted a claim for my hernia repair too. Ins sent it back ( of course) and asked for more info which I did turn in a couple of weeks ago. Still no update yet but I will post when I find something out.

[Nicole74 4]

I am self pay but didn't have a hernia repaired however I do plan on submitting all of my billings to the insurance company anyway...at least I hope that i am able. I just had surgery 2 weeks ago and waiting for the final billing breakdown. I figure its worth a shot just in case they will cover any part of the bill, not getting my hopes up though. I paid $15grand and I do plan to claim what I can on my taxes and at least recoup a little back:)