Question:
having a very hard time getting a plastic surgeon to submit insurance
Does anyone have any suggestions for me or any surgeons in Florida that would even consider submitting my information to my insurance company? I have documents that state that the skin removal from my arms would be medically necessary. I have about ten pounds of loose skin on each arm and for the last 2 years I have severe pain in my arms from them being too heavy. I do hair for a living and the skin makes it very difficult to do when you arms get tired very fast then start to hurt when you try to continue working (doing hair)please help, anyone who knows of a surgeon that will atleast submitt my document to the insurance company for approval.... — latarshabarney (posted on March 29, 2007)
March 29, 2007
If you have HMO insurance, you will need to call your insurance company and
find out who the surgeons are on your plan. The other option is that you
will probably have to have a referral from your medical doctor to follow
that path for the insurance company. The other important thing is to find
a plastic surgeon who is "fellowship trained" This means that
not only did they do their residencies in surgery and are board-certified,
but they spent 1-3 years practicing their future (current) specialty. If I
had my choice, I would choose the specialist. If you can go anywhere, then
I would start with my family doctor, then start looking in the phone book
and doing some research. You can do search engines in their name and find
out their qualifications. The other thing is the AMA (american medical
association) has to, by federal law, list all of the physicians/surgeons
who have had any disciplinary / lawsuit action against them. I think that
you can probably find the link to that site by going to the AMA. Good
luck, as I will be in your shoes someday (but looking for a tummy tuck and
boob job, arms are okay) take care and God bless..........
— Kari_K
March 29, 2007
Your insurance company should have an online provider directory for you to
select from. But it sounds like you may have selected a surgeon that doesnt
accept insurance. I find it difficult to believe that a surgeon just flat
out wouldnt submit your documentation for approval or payment. He probably
has opted NOT to accept insurance. I agree with the previous reply, start
with your provider directory. However, I wouldnt volunteer to much
information to the insurance company. Once you find a surgeon that accepts
Ins.they should know how to get you approved so you dont want to
accidentally give up to much information before the Dr. has a chance to
submit their findings etc....
— _blue_
March 29, 2007
If Tampa, FL. is not to far from Orlando. I have been told this Plastic
Surgeon will fight the Insurance Companies to get them to pay for Medically
Needed Surgeries.
Naji Baddoura, MD - 8001 N. Dale Mabry, Suite 501-F
Tampa, FL 33614 - Phone: (813) 915-1860
But also come to the OH Conference on May 5th, 2007 at the Double Tree
Castle Hotel (Look in Event) in Orlando. A Dr.Shuster - Plastic Surgeon
from Ft.Lauderdale. Will be on hand speaking of his practice but also about
dealing with Insurance. As will the ObesityLawyers.com CEO Gary Viscio,esq.
— Michael Eak
March 30, 2007
I also recommend posting on the Plastic surgery message board. Dr.
Kreithan (?sp) is from Florida and posts occasionally, seems like a nice
guy. You might check him out. He seems sypathetic to the plight of those
of us who have lost large amounts of weight and are trapped in the excess
skin that is so demoralizing.
many PS do not want to submit to insurance. the likelihood of getting arms
covered is slim, no matter what documentation you might have. Your
insurance does not have to cover every procedure that is called medicall
necessary, (and they may disageree on the necessity - just because you or a
dr says it is necessary doesnt mean insurance agrees) they can and do
exclude many procedures. some cover a panniculectomy if it interferes wirh
function, or causes sores or rashes, but more and more are rejecting those
as well. Arms are very rarely covered. Many PS dont want to submit for
insurance because it pays so poorly as well. my ps got $1200 from ins for a
TT, and a normal charge is about 5K. and since he was in my PPO he could
not bill the difference. that covers not only the surgery time, but the 3
preop visits, as well as the very extensive follow up over the next year
that he saw me on a regualar basis. ( at least 8-10 visits and I was not
complicated) when you consider his costs, for office rental, paying his
employees, and his malpractice insurance I figure he lost money on it.
I hope you find a Dr who will work on this for you. In the mean time, I
have had procedures not covered by insurance. i worked my butt of extra
hours, over time and did with out a lot to pay out of pocket for it. ( and
continue to sacrifice til 4/2008 whe my last loan payment is due) No
vacations, minimal eating out, No manicures, pedicures etc. I save about
$50 a month just by coloring my own hair, & more shopping Walmart
and not going out to movies etc. I am not spending on my house or buying
anything I dont just have to. It is well worth it. I also took out loans
on my retitrement account.
— **willow**
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