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Insurance Denying PART of Surgery
Prostate Cancer | Last Active: Jan 16 8:04am | Replies (13)Comment receiving replies
What's funny about your PET scan is that I asked my doctor, after my MRI showed bulging, if I should get a PET scan and he said "I doubt the insurance company will approve it but I agree it should be done", it was instantly approved. One has to imagine that a PET scan is more than some stitches to your bladder.
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Oh yeah - and a lot more expensive too! But that was 6 years ago and a LOT has changed in that time…
Out of curiosity, how much is your surgeon billing the insurance company for these extra sutures? there must be an actual procedure code.
Remember, there’s the insurance fee and the real fee. Check to see how much he is charging (submitted fee) vs the “covered fee”. If he is IN network you should only pay the covered fee - THAT’s a FACT!
However, If he is OUT of network he is allowed to charge his submitted or private fee.
IMO, have the surgery done first, argue later!