7 replies to this topic

[ruffneck]

I am recently recovering from a second gyno surgery. The doctor with the first did not get all of the glandular tissue out so it came back. I am like many lifters out there that have gyno but it was not very bad but it drove me crazy because I felt like every time I pulled my shirt off people were looking at my titties!!! In reality the gyno was not that bad at all and the people would ususally make comments about how big I am. Another words my mind was playing tricks on me. Nevertheless I wanted the shit removed again.

I went to a different surgeon and he agreed that it was more than likely recurrence of the gyno and it was according to me if I wanted it removed. I agreed that I thought it was but wanted it taken out. He set me up with a date for surgery and gave me all the things to do the day of. Several days later his office called and told me that my insurance had turned down my precertification for this surgery and if I wanted it done that I would have to pay 50% of the cost up front = $2800.

I have been in the medical field for over 13 yrs. I knew that there was no way an insurance company could say that a male with a knot in his breast should not at least have it biopsied. I called my insurance company and requested an appeal to their decision. They sent me a paper that the doctor or I could fill out. I simply wrote on there that I was in the medical field and had spoken to several physicians about this and we were all in agreements that there was no way that this knot could be ruled to be noncancerous without at least a biopsy since I had a history of breast cancer in my family on both sides. I received approval within a week for a simple needle biopsy. I spoke to the surgeon once again and told him that I did not want a needle biopsy due to the fact that if it was gyno then the needle biopsy would just irratate the tissue and make it worse. I wanted it out!!!

They once again filed the claim for removal and was denied. I called his office and asked the person that was filing the claim how she was coding the claim (insuances have a different code for all procedures and this is how they decide yes or no). She said that they were coding it as " Subglandular Mastectomy due to Gyno". Insurances will not pay for elective surgeries especially if it is something that the person might have caused i.e. steroid use. I told the woman to use a different code "Open Biopsy for removal of possible cancerous tissue" and try it again. They called the next day with approval and the following day I had the surgery.

So: If your insurance denies a precertification on a procedure instruct the office to try a different code. My insurance covered everythng but my copay and 20% of the doctors cost. Total around $1000 out of pocket.
Also if you are going in for an evaluation for gyno make sure that you put that you have a family history of breast cancer. It is better if you tell them that the cancer occured in a male in your family. They can't ask for his chart. All they will ask is what relatioship he is to you. The closer the better -dad, bother, uncle

Just thought this was some interesting facts that might help some body. If I can help anybody that might be having issues with insurance companies then let me know.

[bambam9193]

Very interesting info for sure. Thanks for posting. Makes you wonder if every one treated these forms as if it was for themselves of a family member how many outcomes would be changed.

[Thinkbig]

Great first hand info bro, thanks.

[ItalianMuscle]

I had the surgery as well, and mine was covered 100%. It falls under the breast cancer act of 1998. As long as the surgeon sends the sample in for a biopsy, your good as gold. Mine was binai. It kills me all the time seeing people paying for this procedure out of pocket, as most dont know its covered by insurance. The surgeon billed my insurance company like $5500 I believe..

[Snachito]

Man this would have been great for me.......only I had mine done like 15 years ago and the three surgeries (2 surgeries from the same quack doctor, 1 surgery from one of the best in the field) cost me close to 10,000 bucks in total!!!!

Either way this is AWESOME INFO Ruffneck!!!

[ThatBro]

man, great info. thanks ! now thats the kinda stuff ya need to know.

[piotr]

Good post... you gotta know how to play the game... whatever game it may be... once you know the rules you can finesse things to get done what you need to get done...

piotr

[Cowboytroy]

I wish the hell i would have thought of that. I got mine done a year and half ago and paid 4 grand for it. Got some lipo done also at the same time. I'm good to go no. Freaking doc. stole my chest though.