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Author Topic: Surgery and Insurance  (Read 159 times)

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oscark

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Surgery and Insurance
« on: October 28, 2019, 03:04:19 PM »

Not sure if anyone here will know, but figured it can't hurt to ask.  I have BCBSRI (Blue Shield Blue Cross of Rhode Island).  They already covered Xiaflex treatment in Boston.  Any idea how likely they are to cover grafting surgery?  Assuming they do, can I go anywhere in the country?  Sorry, I should know more, but have never had major surgery as an adult and not sure how it works.

Thanks,

Oscar
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TDix

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Re: Surgery and Insurance
« Reply #1 on: October 28, 2019, 05:04:42 PM »

I also have that insurance, and just had to pay the $300 deductible for my grafting and excision surgery, as long as they cover the surgeon
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46 yrs old, 3 yrs diagnosed, 3 shots of Xiaflex resulting in hematomas/burst dorsal vein or fracture at tip, excision/grafting surgery March 26th successfully performed by Dr Faysal Yafi, pelvic floor therapy with Laureen McVickers

Stabler

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Re: Surgery and Insurance
« Reply #2 on: October 28, 2019, 06:38:40 PM »

Coverage for grafting or any type of surgery is going to vary by plan. You need to contact member services on the back of your insurance card and ask them what your coverage is for the surgery. It will benefit you to know what CPT code (test code) the surgeon will use so you can give that code to your plan. Just telling them “grafting surgery” will not be to your benefit because they won’t know exactly what to look for coverage wise. You should also know what diagnosis or ICD-10 code the surgeon will be using. Your plan will need you to use an IN network surgeon and facility unless you have OUT of network benefits. This means it would be covered but at a higher cost to you because you aren’t using an IN network provider. You can ask the doctor you plan to use if they are in network with your plan and ALWAYS confirm this with your plan yourself.

You should always be your own advocate when it comes to your healthcare coverage. It is recommended (by me) that you call more than once to get this information from your plan so you know if you are given accurate information and always get the name of the person you speak with and a call ref # if they give those (always ask for one)

Stabler
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Moderator since 2015- Missouri- I work in the medical field and have strong knowledge of insurance and how to obtain coverage for medication and other treatments. Being a woman I do not have Peyronies but you can ask me anything. I am happy to help.

TDix

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Re: Surgery and Insurance
« Reply #3 on: October 28, 2019, 07:40:16 PM »

Exactly Stabler, and also I will say that my Dr (Yafi) must've gone above and beyond because I went through a period of not being approved for the facility (UCI) even though I was approved for the Dr.  I was expecting to pay close to $16000, then $5000, and ultimately when I checked in I found out it was just my deductible.  I double checked what the admitting said when they were like "you only owe your deductible".  I was like "yeah, but I was told I would pay blah blah blah"....and she said "trust me if you owed us more we would know, you wouldn't get the operation without the payment being cleared"
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46 yrs old, 3 yrs diagnosed, 3 shots of Xiaflex resulting in hematomas/burst dorsal vein or fracture at tip, excision/grafting surgery March 26th successfully performed by Dr Faysal Yafi, pelvic floor therapy with Laureen McVickers

oscark

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Re: Surgery and Insurance
« Reply #4 on: October 29, 2019, 01:26:25 PM »

Thanks guys.  This is all helpful.
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