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Wiki Anesthesia - Self pay vs billing insurance

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melaustria27@gmail.com

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Hi,

New to billing anesthesia.

Does anyone know if anesthesia would be covered by insurance if the medical procedure is self pay?

For example, elective procedures (cosmetic) is self pay to the doctor. Would insurance cover anesthesia or self-pay? The medical provider would not be billing the elective procedure. So, would the insurance company question why there is a claim for anesthesia. But, no corresponding medical procedure.
 
Anesthesia is one component of the service which also includes the surgery and facility charges, so it should all fall under the same insurance benefit and have the same coverage. So if the surgery is not covered and will be self pay, then so should the anesthesia and all of the other associated services.

Some insurance companies may not recognize from the claim data that the anesthesia was for a non-covered surgical procedure, especially as you say if there is no surgical claim on file, so they may make payment in error, in which case they may also recoup that payment at a later date if and when they discover the error, so I would recommend treating the anesthesia as self pay and getting a waiver and payment from the patient in any case just to protect your provider.
 
In my experience with coding anesthesia for these "cosmetic procedures" that it was something that was discussed upfront. They patient signed acknowledgement that they would be charged for the anesthesia (that is not part/included with the surgical procedure and simply "out of pocket"). I also clearly remember an AAPC conference like 5 or 6 years ago at the Rochester, MN location and we had a "plastics surgeon" speak on all the wonderful cosmetic procedures he performed that were sometimes malignancy related and sometimes not (cosmetic). I clearly remember him stating that it was the anesthesia that would be a large portion cost of those procedures. I could go and search my files on this for further information, but he was a brilliant surgeon and spoke passionately about his work and I also remember him replying to someone (a colleague) asking how much xxxxxxx procedure cost and he simply replied the "cost of a new small car".
I have worked anesthesia denials for years. I also have personally called the insurance companies with those difficult questions. At the facility I worked for we were to be 3 days out coding anesthesia charges. We already knew from reviewing the HARs that the surgical procedure hadn't been posted yet. So, you send the anesthesia claims (both MD and CRNA) out and very quickly receive a denial. I found out the hard way long ago for many insurers that you need to have the primary surgical procedure billed before they will pay for the anesthesia. Per phone conversations - they will pay the anesthesia once the surgical procedure has been paid. I agree with Thomas that these types of cases should be treated as self-pay and getting the waiver signed and payment to protect your provider is a fantastic solution.
Thank you for listening and have a wonderful evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
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