Insurance covers TT doc is talking cosmetic cost

[Fit2btied 122]

My insurance has approved codes 15830 and 15847.

My question is for anyone who knows about insurance. When the plastic surgeon called they said they wanted me to come in and go over my insurance benefits and discuss the "cosmetic" cost of the procedure. Are they going to try and sell me other things or are they going to try and tell me that there are things that are my cost that really shouldn't be? Insurance said they are covering both procedures and everything that goes along with them so what could I possible have to discuss cosmetically?

Any info would be greatly appreciated!

Here's what my insurance states:

Clinical Conditions

Reconstructive

Abdominoplasty

When the following conditions are met:

• Panniculus hangs to or below the level of the pubis; and causes chronic intertrigo that consistently reoccurs or remains refractory to appropriate medical therapy that includes systemic antibiotics, topical anti-infectives, anti-inflammatory medication and appropriate skin hygiene; OR
• Repair of diastasis recti in the presence of a true midline hernia (ventral or umbilical).

[Jersrose43 837]

They could be wanting to discuss your portion of the costs. Such as copays, coinsurance a, deductibles. Or they could be out of network and want the difference between what the insurance approves and their charge (only applies to out of network docs)

[Fit2btied 122]

They could be wanting to discuss your portion of the costs. Such as copays, coinsurance a, deductibles. Or they could be out of network and want the difference between what the insurance approves and their charge (only applies to out of network docs)

Thanks! They are in network and I just get the feeling they don't like working with insurance bc their cut is less that way. So I'm trying to gather as much info as I can so if they try to tell me I owe for this or that I can come back with facts.

[labwalker 1,177]

Insurance may pay only to correct a medical problem, but leave cosmetic concerns unpaid. You may have some out of pocket to do other surgery that the insurance may consider to be non-covered. Just guessing. But most surgeons want to make patients well aware that they are responsibile for bills that the insurance does not pay.

[Kitt3000 757]

Don't forget, you can always get another opinion :-)

[Fit2btied 122]

I am seeing 2 other plastics that week..lol

Don't forget, you can always get another opinion :-)

[Bronco0605 135]

I just went to my second consult and the doctor explained that my insurance would cover the panniculectomy ( abdominal skin removal) below the belly button This is the part that some people and doctors call the fatty apron, the portion that hangs below the pubis. My insurance does not cover the muscle repair, and the vertical cut and skin removal above the belly button. I will have to pay $2200 for that portion of the surgery. I really want to have a good result.

[Fit2btied 122]

Did your insurance cover both 15830 and 15847? Or was it just the 15830 because that's the code for just the skin removal. 15847 covers the cost of the fixing of the belly button and tightening. Thanks for the reply.

I just went to my second consult and the doctor explained that my insurance would cover the panniculectomy ( abdominal skin removal) below the belly button This is the part that some people and doctors call the fatty apron, the portion that hangs below the pubis. My insurance does not cover the muscle repair, and the vertical cut and skin removal above the belly button. I will have to pay $2200 for that portion of the surgery. I really want to have a good result.

[AZDee 138]

Fit2btired, have you gone to your PS visit yet? I am sure if you haven't that your PS wants to give you the option of doing more while you are in the OR...Give it some thought it could save you a lot on later plastic surgery....Most of the time they will give you the option of including the muscle tighting to the panni. I know someone who had her panniculectomy a couple of weeks ago, also paid by insurance and while the doctor was in there he decided to go ahead and tighten the muscles for her....She was very pleasantly surprised, since the doctor knew she couldn't afford to pay to have it done...Give us a update...

Edited July 14, 2014 by AZDee

[Kitt3000 757]

It's nice to hear about the ps who did such a kindness. Thanks for posting that, I hope she pays it forward!

[Fit2btied 122]

Fit2btired, have you gone to your PS visit yet? I am sure if you haven't that your PS wants to give you the option of doing more while you are in the OR...Give it some thought it could save you a lot on later plastic surgery....Most of the time they will give you the option of including the muscle tighting to the panni. I know someone who had her panniculectomy a couple of weeks ago, also paid by insurance and while the doctor was in there he decided to go ahead and tighten the muscles for her....She was very pleasantly surprised, since the doctor knew she couldn't afford to pay to have it done...Give us a update...

I just got back! She wants to charge $6000 for the rest of the TT. Initially the TT was $10,000. I will not pay the $6000. I can't afford it and if I add my deductible into the cosmetic costs it's almost the same as paying outright. I have 3 other opinions to go to this week. So now I need to research getting just the pani done. I will update again after my other consults.

[AZDee 138]

Wow that is a lot of extra money just to have the muscles tightened...Makes me wonder how good of a job she would do if you don't pay up the extra??? Glad you are going to other consults. I know plenty of people who have just had the panni and been thrilled with the results, and you also get the bellybutton redone, so you should look pretty good. Hope you find a good honest doctor who can help you...

[Fit2btied 122]

Wow that is a lot of extra money just to have the muscles tightened...Makes me wonder how good of a job she would do if you don't pay up the extra??? Glad you are going to other consults. I know plenty of people who have just had the panni and been thrilled with the results, and you also get the bellybutton redone, so you should look pretty good. Hope you find a good honest doctor who can help you...

I feel the same way about the price. It's like I will do the pani but it's not going to look good unless you agree to the TT. I'm thinking I won't go with her regardless of what the others say. She is obviously in it for the money.

[LilBoo007 491]

I agree 100%! My dr. Did my full Tummy Tuck and for free he did my flanks for free! Also when doing my breast lift he took away the extra skin on the side.. I was soo pleased and happy he did that for me.. He went above an beyond what he was supposed to do.. That's the kind of surgeon everyone wants to get!

[Fit2btied 122]

I agree 100%! My dr. Did my full Tummy Tuck and for free he did my flanks for free! Also when doing my breast lift he took away the extra skin on the side.. I was soo pleased and happy he did that for me.. He went above an beyond what he was supposed to do.. That's the kind of surgeon everyone wants to get!

Where is your plastic surgeon out of, I need him. Lol