Results 1 to 6 of 6

deductible for complete surgery

  1. #1
    Default deductible for complete surgery
    Exam Training Packages
    breast surgery carried over into new deductible year

  2. #2
    Lightbulb
    Staged procedure? If so, try splitting the claims up into 2010 service dates on one, and 2011 on the other; then send a reconsideration request/corrected claim, advising that services provided in 2010 should be processed for payment utilizing the benefits that the patient had on each service date (for which I'm sure you verified coverage), and not their benefits at the time of adjudication.

    As for the 2011 dates of service; if they're subject to a new deductible, then they're going to have to pay it. A lot of people don't know anything about their insurance coverage, and forget about deductibles (if they even know they've got one). It sucks for patients whose treatment came with bad timing for their insurance coverage, but in the future, you can spot these situations ahead of time, by considering their current plan when you're verifying coverage - did they have a deductible to meet this year? If so, it's not likely to disappear next year. Let the patients know that they're going to be responsible for a portion of the procedure well ahead of time, and you can establish a payment plan with them, rather than shock them with a large bill after the fact. They're going to have to meet that deductible sometime, anyways - might as well get it over with early. Hope that was some help...

  3. Default
    I can tell you that my personal insurance includes anything paid toward a deductible in the last three months of the previous year (last quarter) it is carried over to the new year. For instance, if I had a surgery done in November 2010 and had to pay $500 towards my $1500 deductible, then come January 2011 my deductible to meet is only $1000. You may want to check and see if any of the patients deductible from the previous year (quarter) transfers to the new year. If not, then the patient is still responsible regardless. I would talk with the patient before hand and see if you can work out a payment plan with them. Especially with the economy being as bad as it is, a lot of people do not have that type of money to pay all at one time (obviously if they have a high deductible). Just my two cents. Hope it helps.

  4. #4
    Default
    Thank you for your quick input, I really appreciate it. The patients, my sister, insurance was up to date in 2010 and continued into 2011. Her breast cancer surgery started in feb of 2010 and due to surgery complications/ infections it continued into march 2011. Due to these complications, she ended up having a total of 7 surgeries in all. Her deductible is 2500.00 with a 2500.00 coinsurance, not something she can easily meet or hopes to. All the same, I really appreciate your input, so let me ask you, do you think I could argue this with Aetna? Since they crossed over global days,do you think they will consider it all toward the one 2010 deductible? Or is a new year a new deductible regardless? thanks, look forward to hearing from you

  5. #5
    Default
    Quote Originally Posted by krainko View Post
    Thank you for your quick input, I really appreciate it. The patients, my sister, insurance was up to date in 2010 and continued into 2011. Her breast cancer surgery started in feb of 2010 and due to surgery complications/ infections it continued into march 2011. Due to these complications, she ended up having a total of 7 surgeries in all. Her deductible is 2500.00 with a 2500.00 coinsurance, not something she can easily meet or hopes to. All the same, I really appreciate your input, so let me ask you, do you think I could argue this with Aetna? Since they crossed over global days,do you think they will consider it all toward the one 2010 deductible? Or is a new year a new deductible regardless? thanks, look forward to hearing from you
    I would try to fight it. Ask for written disclosure on their policy for staged or related procedures. I could understand trying to package all of the services into one, if she were an OBGYN patient, having a baby in the new year, but complications of cancer treatment aren't predictable. She had no control over the fact that she wouldn't be better by the start of the new year; all of the services provided in 2010 should be subject to her coverage available on the date the services were rendered. Good luck!

  6. #6
    Default
    Thank you so much. I will and I will let you know how it turns out.

Similar Threads

  1. deductible
    By nc_coder in forum Billing/Reimbursement
    Replies: 1
    Last Post: 09-13-2012, 06:37 PM
  2. Deductible
    By nc_coder in forum OB/GYN
    Replies: 0
    Last Post: 09-11-2012, 08:18 AM
  3. Deductible
    By bmanus in forum Billing/Reimbursement
    Replies: 4
    Last Post: 05-18-2012, 10:02 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.