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Author Topic: Nail removal question, questions for USA ppl w/ health insurance  (Read 438 times)

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SpeedDialer

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Nail removal question, questions for USA ppl w/ health insurance
« on: September 07, 2021, 05:39:01 PM »

Some USA doctors mentioned that they can sometimes get nail removal helped by USA insurance. I got the CPT, ICD, and NPI codes for nail removal.

I'm going to call USA health insurance companies in my area and give them the CPT, ICD, and NPI codes  to ask if they cover it.

However, as I am talking to the health insurance sales guy, what I'm finding is that they will then ask me questions like this:
- what kind of device is in there
- what kind of treatment is it
etc

And I wonder to myself- should I tell them those things? What should I say back? It seems like talking about that info could be used against me later? Should I not even give them CPT, ICD, and NPI codes for nail removal? But if I don't tell them CPT, ICD, and NPI codes then it seems like a gamble to sign up for health insurance with them not knowing if they will cover it and the doctor in question

What would you recommend I do?

If I go to Assayag or someone and get the operation done, is there any chance the doctor's office will say insurance will cover it, but insurance denies it and I end up having to pay for all of it out of pocket?
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Want-3-inches

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #1 on: September 07, 2021, 07:31:55 PM »

Unfortunately insurance coverage is never guaranteed. It's always "submit and see". A supportive doctor will increase your chances of coverage but no one will guarantee coverage.

Read Dr Rozbruch's diaries. Some of his patients got insurance coverage for CLL itself and some didn't. And they didn't know until after the surgery was booked.

When you talk on the phone with the agent, you can just tell them the truth if they don't know who you are, and see what the agent says.
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Shatter. Gee. 11

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #2 on: September 07, 2021, 08:47:36 PM »


Read Dr Rozbruch's diaries. Some of his patients got insurance coverage for CLL itself and some didn't. And they didn't know until after the surgery was booked.


WHAT? FOR THE ENTIRE CLL? Is that even possible? So it's all random? or did they do something differently?
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Height now 166 cm
Desired Height 177 cm

Plan- LON tibia 6 cm, LON femur 5 cm

KiloKAHN

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #3 on: September 07, 2021, 09:53:53 PM »

I was able to get frames removed for my Platinum plan's rate of $250 for outpatient surgery through my Kaiser Permanente insurance. He just wrote down that it impeded my quality of life and put in the correct codes, and this is after I already told my doc that I went to have a cosmetic lengthening procedure. Doctors with experience should know what the best way of wording a claim is, and they can always appeal if it's initially denied.

If you withhold info/lie and the insurance company finds out about it later, then it's able to withdraw coverage and you can later be sent a massive bill.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Activatedxx

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #4 on: September 07, 2021, 09:56:28 PM »

Some USA doctors mentioned that they can sometimes get nail removal helped by USA insurance. I got the CPT, ICD, and NPI codes for nail removal.

I'm going to call USA health insurance companies in my area and give them the CPT, ICD, and NPI codes  to ask if they cover it.

However, as I am talking to the health insurance sales guy, what I'm finding is that they will then ask me questions like this:
- what kind of device is in there
- what kind of treatment is it
etc

And I wonder to myself- should I tell them those things? What should I say back? It seems like talking about that info could be used against me later? Should I not even give them CPT, ICD, and NPI codes for nail removal? But if I don't tell them CPT, ICD, and NPI codes then it seems like a gamble to sign up for health insurance with them not knowing if they will cover it and the doctor in question

What would you recommend I do?

If I go to Assayag or someone and get the operation done, is there any chance the doctor's office will say insurance will cover it, but insurance denies it and I end up having to pay for all of it out of pocket?


Technically all cosmetic surgery even if there is a complication as a result should be denied

But my frame removal, follow up care, and physical therapy was all covered by insurance

I have blue cross blue shield

Honestly if something is really impeding your quality of life or health they should cover it. You don’t ask the insurance yourself, just have the doctor bill them and do everything, that’s what my doctor did at least
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5’5 starting. 8cm distracted. External LON Femur Buldu (Turkey) 2021. Nail removal at HSS (USA) .
Tibia external TSF 10-2024, Assayag (Usa). In progress.
If considering external femurs please change your mind

SpeedDialer

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #5 on: September 08, 2021, 12:22:22 AM »

"Technically all cosmetic surgery even if there is a complication as a result should be denied

But my frame removal, follow up care, and physical therapy was all covered by insurance

I have blue cross blue shield

Honestly if something is really impeding your quality of life or health they should cover it. You don’t ask the insurance yourself, just have the doctor bill them and do everything, that’s what my doctor did at least"

Thank you!!! Do you need to live near a leg lengthening doctor for this in your insurance area's network or just any orthopedic surgeon in your insurance network area? What about internal rod removal?
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SpeedDialer

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #6 on: September 08, 2021, 12:24:34 AM »

Thank you!!!

So if you were trying to figure out the cheapest method for nail removal, what would you do?

1. It seems like I could pay for a consultation with Dr. Assayag. And then I won't know until after its done until whether the insurance company approves it right? So it is a bit of gamble to see if the insurance company will approve it?

2. The other option would be to book an appointment with Parihar I guess and fly over to him and pay everything out of pocket

What would you do?

It must be a leg lengthening doctor to do nail removal right, not just any orthopedic surgeon? Or not matter?
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Want-3-inches

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Re: Nail removal question, questions for USA ppl w/ health insurance
« Reply #7 on: September 08, 2021, 03:52:00 AM »

WHAT? FOR THE ENTIRE CLL? Is that even possible? So it's all random? or did they do something differently?

Part of CLL. One guy paid $55k for it at the HSS where it would have normally costed 125k. It can't be guaranteed. So no one should attempt to do this procedure unless they have money for it and nail removal and potential complications.

If it was guaranteed that everyone gets to do it for $55k at the HSS in New York why would anyone even leave the country for this procedure?
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