Implants

vmounce

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A patient comes in for procedure. Didn't know until during procedure that doctor would have to use implants. So patient did not sign sign consent for the implants. What would we do in this case?

I appreciate any information.

Vickie
 

JMeggett

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If patient signed consent for the procedure wouldn't anything that is necessary to complete that procedure be covered by that signature? If surgeon is in middle of procedure and realizes the implant is needed....he's not going to close patient up, wait till patient wakes up to ask permission & get sig, then give anesthesia again or even reschedule. I think if patient signed for the procedure then you are covered. :)
 

vmounce

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Okay. I understand your point. The patient has Blue Cross and Blue Shield. The insurance will not pay for the implant. Do we bill the patient for the implants?

I appreciate the info.
 

elenax

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I don't bill the patient, the insurance company pay implants at their discretion and usually when they deny it, it is because they consider the same included in the main procedure...interesting subject would like to hear more feed back:eek:
 

JMeggett

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We actually had to do a "carve-out" in our contracts with some of our biggest payors just for ortho implants. And even then I have to attach a copy of that implant ASC contract to the HCFA for each different carrier....just so they don't try & deny as "not a covered item". If you don't have those covered per your contracts...I'm so sorry...you'll struggle getting reimbursed. So yes, make sure in future you've got those ABN's signed before sx "just in case". :) Good luck!
 

cconroycpch

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Implants is something that certainly should be considered part of the contract. It is always best to get them carved out and reimbursed at cost + %. Some insurance companies are paying based off the Medicare allowed amounts and the reimbursement for implants are already considered, therefore no additional reimbursement will be made. You will need to review all of the current contracts by insurance company on how each handles implants.
 
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