Friday, November 9, 2012

Reconstruction--Never, Ever a Simple Process

I've been thinking about doing a year-end push to finish up my reconstruction, but it could be that there's not enough time to work out the annoying details.

Two things made me decide to even think about trying this--there is a study about Cook nipple implants with one of the four sites nearby, and our insurance deductible will be much higher next year.

So I've been in touch with the study site, but I'm not loving their emphasis on the financial side of things. They offer a free cosmetic consultation but charge reconstruction patients a consultation fee. They'll refund it if my insurance company pays 100% of the amount they submit. Ummm, we all know that's not going to happen; it's why they insist on the fee in the first place.

Secondly, they are not in-network with any insurance. This is not uncommon for plastic surgeons, but it does make the financials a pain in the butt. I mean to the point it could easily stop you from getting anything done at all.

This place won't just help me secure an in-network exception (since my insurance likely doesn't have another local doctor doing this type of nipple) and then take what that pays them, plus my 10% co-pay under the in-network agreement.

No, they figure a cost that's 20-30% of what they want to charge (not reasonable and customary that the insurance will knock it back to) and ask me to pay that up front, before the surgery. Then they keep my money and whatever the insurance pays.

Not exactly the most honorable process, if you ask me. Clearly they want to pad what they get from insurance patients, from cancer patients. I know we're not nearly as lucrative as cash-paying, elective cosmetic patients, but to be so blatant about it strikes a sour note with me.

Especially since this is a clinical study, where I would think the doctor and his practice are getting money from the biotech company that makes the nipple.

Nah, this strikes me as too greedy. I have calls and e-mails in to Cook and the other study site directors to see how they charge.

I'll keep you posted.

No comments:

Post a Comment