$8500 surgery assistant??!!!

[Rn925 25]

I have bcbs of Michigan, they were supposed to cover 100% of my surgery. I've been logging on to see what they covered. They denied a charge for "surgery assistant" for over $8000!!!! I have no idea what this is or why it was denied. They paid the dr and the hospital fee completely. Freaking out since I can't call the dr, the office is closed.

[Rn925 25]

Guess I should add that I went through true results. Has anyone experienced this?

[CHEZNOEL 4,061]

The insurance and hospital will sort it out.

[☠carolinagirl☠ 18,722]

dont stress.......call dr in the morning.

it will work out

[line-dancer 810]

call insurance comp. and ask them also.

[jenna35 4]

If the surgery was approved and the insurance company deemed they dr unnecessary they will deny the charges, but you should not be liable. The DR will need to appeal. But, I suggest calling your insurance company and advising them you were unaware an assistant would be there, and could they reconsider the charges.

If the Asst. surgon is par and the services are denied not medicallly necessary you should not be liable for the balance. It is between the insurance , company and the dr to sort out through medical appeal and md reveiw..

[Gigi_Girl 77]

It will prob be a charge off for the doc's office. Just call to confirm. BC requires docs to accept their fee schedule.

[Scooterbug 13]

First thing to do is not panic. Second, if you got your EOB (explanation of benefits) or are able to access them online, you should be able to see all charges listed for your surgery. Next to each charge you SHOULD see a 5 digit code. These are called CPT codes and this is how coders bill for procedures/surgeries.

You will want to try and locate your Gastric Band CPT code..which should be 43770. When an assistant surgeon is used a "modifier" is added to that code in the form of modifier 80. So IF coded properly the Gastric band code should be 43770-80 (Gastric band procedure with the help of an assistant surgeon).

Make sure there are no other codes that have the modifier 80 next to them. Coders do sometimes make mistakes and you want to make sure modifier 80 is not added to a code that insurance would not think would require an assistant surgeon to help with.

So for instance... hypothetically..lets say a coding mistake was made, and modifier 80 was added to the code for placing an IV. The insurance company would say "Why would it take a primary surgeon and his assistant to insert an IV?" That would be denied right away by insurance.

SO.... my suggestion is look over the codes, if it's not too confusing, and make sure everything looks right OR call the insurance company and ask why they denied the charges for the Assistant Surgeon. If it was a coding mistake it should be easily fixed by your surgeons office and resubmitted.

[Rn925 25]

First thing to do is not panic. Second, if you got your EOB (explanation of benefits) or are able to access them online, you should be able to see all charges listed for your surgery. Next to each charge you SHOULD see a 5 digit code. These are called CPT codes and this is how coders bill for procedures/surgeries.

You will want to try and locate your Gastric Band CPT code..which should be 43770. When an assistant surgeon is used a "modifier" is added to that code in the form of modifier 80. So IF coded properly the Gastric band code should be 43770-80 (Gastric band procedure with the help of an assistant surgeon).

Make sure there are no other codes that have the modifier 80 next to them. Coders do sometimes make mistakes and you want to make sure modifier 80 is not added to a code that insurance would not think would require an assistant surgeon to help with.

So for instance... hypothetically..lets say a coding mistake was made, and modifier 80 was added to the code for placing an IV. The insurance company would say "Why would it take a primary surgeon and his assistant to insert an IV?" That would be denied right away by insurance.

SO.... my suggestion is look over the codes, if it's not too confusing, and make sure everything looks right OR call the insurance company and ask why they denied the charges for the Assistant Surgeon. If it was a coding mistake it should be easily fixed by your surgeons office and resubmitted.

I liked at the eob, no codes listed on there. Called the office, was told someone would get back to me, and they never did.