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Breast Cancer Sucks, Love Amy: January 26, 2023: Coverage!

Coverage!


Got the call from the plastic surgeon's office, I'm preauthorized for reconstruction of both breasts!


The take away:

Find out the the codes that your doctor's office (surgeon's office) are planning to use to submit to the healthcare insurance company.  You'll need the CPT codes, the diagnosis codes, and your doctor's Tax ID.


Call your healthcare insurance company's Authorization Department with these codes and get them to open up an authorization case for each of your surgeons respectively.  Get the respective authorization reference numbers.  Give these authorization reference numbers to your doctor's office, these case numbers allow the surgeon's office to attach any relevant clinical data and evaluations to build the case for the "medical necessity" of your procedures.  As I have heard repeatedly, it all boils down to whether or not the doctor can make a case for medical necessity.

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