A brief word about how our fees are determined is certainly in order.
Plastic Surgery Associates of Tidewater, Inc. deals with dozens of different insurance companies. We have tracked our fees and insurance reimbursements from year to year. Our fees are based on an extensive experience, and represent the usual and customary for this geographic area.
Occasionally, a patient will state, "I know someone who had this done and it only cost . . . ." We cannot control what other physicians charge. They may offer cut rates in order to attract more patients. In our office you are paying for the expertise earned through twelve to sixteen years of post graduate education, including sub-specialty fellowship training, as well as experience practicing in the Tidewater area of Virginia, and throughout the world in Operation Smile International since the mid 1980's.
With most functional surgery we can give you an idea of the cost of surgery, but not an exact fee for the proposed operation. This is because the fee is contingent on the size of the lesion being removed, whether it is benign or malignant - which will only become apparent after the analysis by pathology - and the extent of the reconstruction required. In most cases, functional surgery should be covered by your insurance carrier and your liability for payment would normally be limited to co-pays, cost shares, and deductibles.
Cosmetic surgery is not covered by insurance carriers. . In most of these instances we can give you an exact fee for the proposed procedures. In addition, because of our long term association with local medical facilities we can offer package rates on most cosmetic procedures, that includes a set fee for anesthesia and hospital costs as well as surgical fees. If you are simply shopping around for the cheapest price please do not waste time visiting us, as your mother says, "you get what you pay for."
Plastic Surgery Associates of Tidewater participates with several financing programs. We are pleased to recommend CareCredit
which is endorsed by the American Society of Plastic Surgeons, and which many patients have found to work best.
CareCredit: CareCredit for cosmetic procedures
We’re pleased to offer our patients the CareCredit® card, North America's leading patient payment program. CareCredit lets you begin your treatments immediately — then pay for it over time with convenient monthly payments that fit easily into your budget. Now you don’t have to save up for years to finally get the treatments you’ve always wanted.
Like a credit card, but better
CareCredit works just like a credit card, but is exclusive for healthcare services. With low monthly payments every time you use it, you can use your card over and over for follow-up appointments or different procedures. This means you don’t have to put your health and beauty on hold until you save up enough money. We give you the power to decide when it’s the right time for you.
We also accept most major credit cards for your convenience in paying for services.
We participate in the insurance program endorsed by the American Society of Plastic Surgeons to cover expenses in the unlikely event of an intra-operative or post-operative complication. You are automatically enrolled in the program and PSAT pays the premium. While problems during or after surgery have been rare in our nearly fifty years of combined experience we want you to have the extra peace of mind that if something untoward happens you will not be left facing huge hospital bills. Click here
to get more information about CosmetAssure. Just another great reason to visit us and see the difference.
The world of health care insurance is rapidly, even daily, changing. We are trying hard to keep up with the multitude of changes. We deal with dozens of different insurance carriers each with its own set of rules, regulations, and restrictions. Criteria for coverage varies from insurance company to insurance company, and can even vary tremendously depending on the type of policy within a given company. The following information applies to insurance carriers in general and may not address your specific situation.
1. Today's Visit:
If your insurance carrier still allows you to choose your own physician, even your own specialist, you are fortunate. In this case you probably do not need any referral from your Primary Care Physician (PCP) in order to have today's visit covered by your insurance carrier. Almost all managed health care systems, on the other hand, require you to see your PCP first and receive a referral for today's visit. There are some things which you must know about this referral:
You must present the referral to our receptionist at the time you check in. If you do not have a referral, but your insurance company requires one, then you may agree to pay for the visit yourself, or reschedule your appointment and obtain the necessary referral.
Some insurance companies and/or PCP offices will agree to fax a referral to our office. Our receptionist may be able to assist you, but please understand it is not her responsibility, but yours, to secure the necessary referral. There is a phone in the waiting room (at our Harbour View Office) for your convenience in calling your PCP if there are any problems.
Most insurance companies now require a co-pay for each visit. You must be prepared to make this payment before being seen.
Your referral is an authorization for today's examination and no matter what it says on the sheet it is not an authorization for surgery.
2. Co-pays, Cost Shares, and Deductibles:
Co-pays, cost shares, and deductibles may be a part of your insurance policy. These are your obligation to which you have agreed by choosing your particular carrier. Please understand that we are legally bound to collect these fees when applicable. We cannot under any circumstance write them off for anyone, not even for our mothers!!!
3. Participating vs non-Participating:
We “participate” with most insurance carriers. This means we agree to accept that particular carrier's payment, along with any co-pay, cost share, or deductible required by the policy, as payment in full for our service. Any part of our fees which fall above this amount are automatically written off. In this circumstance you should not be balanced billed and are obligated only to pay the appropriate co-pay, cost share, and/or deductible. Our relationship with some carriers is "non-participating." In these instances we can treat the patients, but do not have a prearranged agreement to accept the carrier's allowed amount as payment in full and we are required to balance bill the patient. Insurance carriers on occasion have allowed balances to be adjusted. Any decision to write off part of the fee after insurance payment is subject to these constraints and up to the discretion of your physician. In these circumstances we are once again obligated by law to collect co-pays, cost shares, and deductibles.
4. Functional vs Cosmetic:
The criteria for functional vs cosmetic surgery are determined by each insurance carrier. The requirements for surgery to be covered can therefore vary tremendously. Your carrier should have guidelines they will give you for a specific procedure. However, the best way to know if surgery will be covered is to obtain a pre-authorization.
Sometimes surgery will include a portion which is considered functional and another portion which is considered cosmetic. In these instances we will try to secure the necessary authorization from your insurance carrier for the functional portion. You are responsible for co-pays, cost shares, and/or deductibles which apply to the functional part of the procedure, as well as fees for the cosmetic portion. As a general rule, however, operations with combined functional and cosmetic aspects may result in lower overall costs to the patient.
5. Pre-authorization for Surgery:
Occasionally the pre-authorization for your surgery can be obtained over the phone by your Patient Counselor. In most instances forms must be filled out and/or a letter sent to your carrier. This letter will describe your medical history, symptoms and the indications for surgery. The appropriate ICD-9 codes will usually be included. Finally the letter will also contain a description of the proposed procedure(s) with the appropriate CPT codes. Your carrier may also require photographs, letters from referring physicians, and laboratory test results (e.g. EMG, Visual Fields, etc.). Receiving an answer back from your insurance company may take as little as 3-4 weeks or, in a few cases, as much as 3-4 months. Sometimes additional information will be requested which delays the process. If authorization for your surgery is denied, the matter can usually be appealed. We have found over the years that, following an initial denial, patients who become personally involved in the pre-authorization process have the best chance of ultimate success. From time to time a patient will say, "I heard that if you'll just word the letter a certain way they will cover my operation." Rest assured, after many years of dealing with insurance companies we have learned how best to be your advocate. We will do everything which is honest to see that you receive the benefits to which you are entitled under your insurance plan. When pre-authorization is received we can then proceed with your surgery. If authorization is ultimately denied then you must decide if you wish to go ahead and pay yourself to have the procedure done.
6. Miscellaneous Considerations:
As noted above this brief review of insurance matters cannot possibly address all the fine nuances of the rapidly changing world of health care insurance. A few other miscellaneous items may however be of help.
Sometimes specific procedures, although considered functional, are excluded as part of a particular insurance policy. If this is the case there basically is no room for discussion or appeal.
Some government sponsored insurance programs will not pre-authorize any surgery. All we can do in these instances is give you our best estimate of the likelihood your procedure will or will not be covered. The ultimate decision to proceed must be yours.
When dealing with Tri-Care, "non-availability" does not mean "pre-authorization".
From time to time a patient will state, "My friend had this surgery done and his/her insurance paid everything." Please understand that policies, procedures, coverages, and payments vary tremendously from company to company. Furthermore, indications for surgery also vary significantly from patient to patient. We will do our best to see that your carrier provides you the benefits to which you are entitled, but there are no guarantees.