Insurance reimbursement for fills

[CandyB 0]

I figure I'd better start trying to get an answer to this question now. My sister and I are scheduled for our first fills 4/8 with Dr. Borao, Monmouth Medical Center, Long Branch, NJ.

The director of the bariatric surgery center where we are having our post-op care informed me that the hospital portion of the fill (radiology) will be covered by insurance. But the doctor's fee, which is $250., will probably not be covered. Why? Because, according to her, a satisfactory code does not exist for billing the insurance company for the doctor's fee. She said that none of Dr. Borao's lap-band patients has ever been reimbursed for his fill fee. HELP! I feel like we are at the mercy of an inept or uncaring billing clerk at Dr. Borao's office in Shrewsbury, where the billing for HIS fee is done. (Bariatric Center bills for radiology fee).

I was speaking with Don Mills at INAMED and mentioned this problem to him. He gave me some codes which have been succesful for getting reimbursement for the fill procedure. I have shared them with the Bariatric Center director, and I am composing a letter to Dr. Borao, urging him to get his billing clerk on-board in exploring which codes are going to work for reimbursement. (For the doctor's fee INAMED suggested 90799 - unlisted therapeutic prophylactic or diagnostic injection)

Can anyone give me input on this financial problem?

Has anyone's surgeon included his/her first fill fee with his initial surgery fee if done within the 90 day post-op follow-up period? Borao billed my insurance company $12,569 for his surgical fee. Since he does not fill at all at the time of surgery (understandable), I think the first fill (necessary to make the band work) should be included in his original fee. Of course, I'm the one who's paying, and my logic would be VERY different than the surgeon's!

If I have to switch doctors for my fills I am willing to do that, too, since Dr. Borao is out-of-network for me, anyway. So, are there any Monmouth County, New Jerseyites out there who can recommend a trustworthy fill doctor to me?

I would really appreciate your input.

Thanks, candy

[Laura W 0]

I read where someone has her doc to bill this as a doctor's visit, not a fill visit and all she pays is her co-pay.