You Don't Need to Pay Someone Hundreds of Dollars to Submit an Out-of-Network Request for Surgery
I'm spilling the tea! Other insurance experts don’t want you to know how easy this is, and I will save you hundreds of dollars!
We don't talk much about a part of the preauthorization submission that involves asking for your surgeon to be considered in-network so they can get paid for your surgeries. But this is as important as the preauth request.
Ironically, other lipedema “advocates” make thousands of dollars every year providing services for out-of-network exception submissions, off of Lipedema women who don’t know the insurance process.
When I learned that women were being charged hundreds of dollars solely for this particular task, I was appalled.
There is no need to pay another company hundreds of dollars to help with this part of your submission. You can do this yourself!
In fact, if you have been working to submit your preauth for liposuction surgery, the out-of-network (OON) request is a piece of cake.
And I will give you ALL the information you need for your OON request. Without paying other agencies hundreds of dollars for such a simple task.
How simple is it? Well, I’ll tell you…But first, let’s start at the beginning:
Being in-network means that the surgeon has an agreement with the insurance company to accept certain negotiated rates for services provided to patients covered by that insurance plan.
When you need to have your treating physician paid by your insurance and they do not already have a financial contract in place with them, they are considered out-of-network. That doesn’t mean you can’t go to the surgeon, but you must have a pretty good reason why you want to use that doctor over one your insurance is already contracted with.
In our case, most plastic surgeons don’t work with insurance and don’t have prearranged financial contracts with insurance. Most of their services are cosmetic and paid for out-of-pocket by their patients. However, with our surgeries, they aren’t cosmetic and should be covered by insurance. So, you and your surgeon must take that extra step to request insurance to consider the surgeon in-network.
Insurance will only consider this if no alternative surgeon in their network can perform the same surgery. And besides university hospitals that may have some contracted affiliations with insurances, they likely won’t have a plastic surgeon in network.