Question Lesion removal - Insurance denying as not medically necessary

PSegovia

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I work for an Occuplasty Surgeon. We have a lot of patients that come into the office with lesions around their eyes and the insurance companies are not preauthorizing the procedures for removal as they are stating that the code does not need prior authorization. Now they are denying for medical necessity,claiming that the procedure is considered cosmetic. We have even had them use the pathology report in their favor stating that the growth was not malignant. Our samples are sent for biopsy when the growth is removed. We are now looking at doing a biopsy prior to any further treatment on all new patients and if the report is non malignant, explain to the patient that the removal would be a patient responsibility, due to the guidelines of the insurance company. We have experienced this with most of the larger payers. Has anyone else experienced this issue? Have you found a way to get these paid if they are not malignant?
 
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