Kara29
03-05-2009, 11:31 AM
I am putting together a guide so that those of you who are thinking about doing this operation or about to go through with it such as myself in May.
Most Doctor's offices takes care of insurance information for you, BUT it's imperative that you check yourself and do your own homework so that you don't have any surprise bills after it's all said and done.
Call your Insurance about the following:
1. Make sure that every single doctor including the primary surgeon is covered and IN YOUR NETWORK. OUT OF NETWORK DOCTORS ARE NOT COVERED AND YOU OWE IN THE END.
2. Along that regard, also make sure the other Doctors in the whole group of Doctors doing your operation are also IN NETWORK PROVIDERS because if one of then isn't then you owe them in the end.
3. If you don't know how to do this, call your insurance company and ask to speak to a supervisor and be as sweet as honey and you should get a nice person to help you through all of this. If you are not happy with the person who is dealing with your case, hang up and call again to get a different Supervisor. There are many of them.
4. Ask your doctor or the one who deals with Pudendal Nerve diagnosis and treatment costs for a list of Physician Office Charges and the codes for each thing that you are or may be having done there, both through diagnosis and treatment.
For example xxxx and cost for EMG of anal or urethra sphincter, other needle, any technique.
xxxx code and cost for EMG or anal sphincter, any technigue
xxx code and cost for nerve conduction, amplitude, and latency/velocity study, Each nerve, motor w/out F- Wave Study
xxx code and cost for nerve conduction without F- Wave
xxx code and cost for nerve conduction sensory
xxx code and cost for short latency somatosensory evoked potentional StudY, stimulation of any/all peripheral neRVEs or skin sites, RecoRdinG from central nervous system, in lower limbs
(ASK YOUR DOCTOR AND OFFICE STAFF WHICH DIAGNOSIS TESTS THEY WANT TO PERFORM ON YOU AND WHAT THE DIAGNOSIS CODES ARE, SO YOU CAN CALL THE INSURANCE COMPANY TO DOUBLE CHECK TO SEE WHAT TESTS YOU ARE HAVING DONE ARE COVERED AND IN YOUR NETWORK OF DOCTORS.) I only had two tests out of all of those for my diagnosis.....
Make sure your doctor is in your network so you don't get charged a consult fee. Some Doctors don't charge for that and some do. Mine did but because he was in my network, it was only a co-pay for diagnosis and consult fee .
If you go on to have the full Pudendal Nerve Decompression Operation
1. Get from the office your SURGERY CODES
For example xxx code for Decompression Nerve Surgery
xxx for Internal Neurolysis which some don't use this machine and or don't do this it that way.
(These are all examples from my own PNE Journey. Each Doc and Office will do it somewhat differently and have different names for each procedure and surgery. If you can get those diagnosis codes and surgery codes and check it all out with your insurance company's supervisor or their supervisor) I just wanted to give an example to show you all how to take after yourself so that no surprises will come along after diagnosis and the procedures and operations.
A few other things to check your insurance over are:
1. The Hospital that they are using to do all of this (make sure it's in your network)
2. Make sure the other partners in your Doctors office are covered in your network of providers because some of them may not be but they may be assisting your surgeon in the Operation Room.
3. It's imperative that you make sure the Anesthesia Department (which is not always part of your Doctors network is covered by your insurance company. How I do this is I call the Anesthesia Group and I get 5 or 6 random names of Anesthesiologists in their group. I then call my Insurance company and ask if each of those doctors are in my network. They can look it up for you so you have a real person telling you that they are in your network. Some people can do this over the computer but I like to have a real human confirming all of this. So that I can go into surgery knowing I checked it all out. Usually when the random 5 Anesthesiologists are in your network, chances are the whole group of 100 or so also are.
Again, most doctors offices will check this out for you minus the anesthesia team which isn't part of their job. So I check on my own. I learned the hard way from an operation I had in NYC where the Secretary told me she had checked it all out and everything was covered only to find out in the end that I owed the over 7,000 Dollars to the Anesthesia Team, which was out of network. You live, You learn.
Ask your Doctors Office if they have any informational packets explaining the diagnosis procedures as well as the consult fee and the Pudendal Nerve Decompression Surgery.
You may want to ask them for a listing of potential hotels you can stay at that are around the area. Ask them if you can use the corporate account for that office if you can get a discount on the rooms for the time you are there. My office does have a discount for the Marriot Residence Inn.
This sounds like a Lot but it's the homework you have to do to make sure you are fully covered and don't have to worry about any bills later on. Your Doctor should be able to provide you with a list of codes both procedure codes and surgery codes.
I hope this helped some of you instead of making it more confusing.
And if you are not sure about any of this.....pick up the phone and call your Doctor for explanation of each procedure and which ones he plans on doing on you. There is no such thing as a stupid question.
Warm Hugs,
Kara
Most Doctor's offices takes care of insurance information for you, BUT it's imperative that you check yourself and do your own homework so that you don't have any surprise bills after it's all said and done.
Call your Insurance about the following:
1. Make sure that every single doctor including the primary surgeon is covered and IN YOUR NETWORK. OUT OF NETWORK DOCTORS ARE NOT COVERED AND YOU OWE IN THE END.
2. Along that regard, also make sure the other Doctors in the whole group of Doctors doing your operation are also IN NETWORK PROVIDERS because if one of then isn't then you owe them in the end.
3. If you don't know how to do this, call your insurance company and ask to speak to a supervisor and be as sweet as honey and you should get a nice person to help you through all of this. If you are not happy with the person who is dealing with your case, hang up and call again to get a different Supervisor. There are many of them.
4. Ask your doctor or the one who deals with Pudendal Nerve diagnosis and treatment costs for a list of Physician Office Charges and the codes for each thing that you are or may be having done there, both through diagnosis and treatment.
For example xxxx and cost for EMG of anal or urethra sphincter, other needle, any technique.
xxxx code and cost for EMG or anal sphincter, any technigue
xxx code and cost for nerve conduction, amplitude, and latency/velocity study, Each nerve, motor w/out F- Wave Study
xxx code and cost for nerve conduction without F- Wave
xxx code and cost for nerve conduction sensory
xxx code and cost for short latency somatosensory evoked potentional StudY, stimulation of any/all peripheral neRVEs or skin sites, RecoRdinG from central nervous system, in lower limbs
(ASK YOUR DOCTOR AND OFFICE STAFF WHICH DIAGNOSIS TESTS THEY WANT TO PERFORM ON YOU AND WHAT THE DIAGNOSIS CODES ARE, SO YOU CAN CALL THE INSURANCE COMPANY TO DOUBLE CHECK TO SEE WHAT TESTS YOU ARE HAVING DONE ARE COVERED AND IN YOUR NETWORK OF DOCTORS.) I only had two tests out of all of those for my diagnosis.....
Make sure your doctor is in your network so you don't get charged a consult fee. Some Doctors don't charge for that and some do. Mine did but because he was in my network, it was only a co-pay for diagnosis and consult fee .
If you go on to have the full Pudendal Nerve Decompression Operation
1. Get from the office your SURGERY CODES
For example xxx code for Decompression Nerve Surgery
xxx for Internal Neurolysis which some don't use this machine and or don't do this it that way.
(These are all examples from my own PNE Journey. Each Doc and Office will do it somewhat differently and have different names for each procedure and surgery. If you can get those diagnosis codes and surgery codes and check it all out with your insurance company's supervisor or their supervisor) I just wanted to give an example to show you all how to take after yourself so that no surprises will come along after diagnosis and the procedures and operations.
A few other things to check your insurance over are:
1. The Hospital that they are using to do all of this (make sure it's in your network)
2. Make sure the other partners in your Doctors office are covered in your network of providers because some of them may not be but they may be assisting your surgeon in the Operation Room.
3. It's imperative that you make sure the Anesthesia Department (which is not always part of your Doctors network is covered by your insurance company. How I do this is I call the Anesthesia Group and I get 5 or 6 random names of Anesthesiologists in their group. I then call my Insurance company and ask if each of those doctors are in my network. They can look it up for you so you have a real person telling you that they are in your network. Some people can do this over the computer but I like to have a real human confirming all of this. So that I can go into surgery knowing I checked it all out. Usually when the random 5 Anesthesiologists are in your network, chances are the whole group of 100 or so also are.
Again, most doctors offices will check this out for you minus the anesthesia team which isn't part of their job. So I check on my own. I learned the hard way from an operation I had in NYC where the Secretary told me she had checked it all out and everything was covered only to find out in the end that I owed the over 7,000 Dollars to the Anesthesia Team, which was out of network. You live, You learn.
Ask your Doctors Office if they have any informational packets explaining the diagnosis procedures as well as the consult fee and the Pudendal Nerve Decompression Surgery.
You may want to ask them for a listing of potential hotels you can stay at that are around the area. Ask them if you can use the corporate account for that office if you can get a discount on the rooms for the time you are there. My office does have a discount for the Marriot Residence Inn.
This sounds like a Lot but it's the homework you have to do to make sure you are fully covered and don't have to worry about any bills later on. Your Doctor should be able to provide you with a list of codes both procedure codes and surgery codes.
I hope this helped some of you instead of making it more confusing.
And if you are not sure about any of this.....pick up the phone and call your Doctor for explanation of each procedure and which ones he plans on doing on you. There is no such thing as a stupid question.
Warm Hugs,
Kara