We will request your insurance information before your arrival at the office or at the time of your appointment. At the initial consultation Dr. Papafragkou and Dr. Rhee will examine you and determine if you are eligible for the procedure, you are looking for. Pictures will be obtained for your insurance company. Please bring any supporting documents with you during the visit. For example, if you suffer from back pain due to large breasts please bring with you any documentation you may have from physical therapy, chiropractor’s notes or your primary care doctor. Some insurance plans want to make sure all conservative measures have failed before authorizing surgery.
Immediately following your initial visit, a pre-authorization request will be filled with your insurance company. Most insurance companies will want to review all the medical information provided including any imaging studies and/or supporting documentation before pre-approving/Pre-authorizing a surgical procedure.
Please note that a pre-approval is not guarantee of payment but helps us submit a claim after your procedure. In addition to this the hospital where the procedure will be performed will require us to see a pre-authorization before they allow us to schedule the surgery.
In some rare cases pre-approval may not be required from your insurance company. If that happens then we apply for a pre-determination to make sure that your insurance company agrees with the medical necessity of your case. This again is not a guarantee of payment but helps us with the claim afterwards. If pre-determination is not allowed by your insurance company, then your potential financial responsibility will be discussed on an individual basis.
We will bill your insurance plan after the procedure is done. Dr. Rhee, Dr. Papafragkou and their team are out of network. Each insurance policy is unique with different deductibles, co-insurance and potential plan exclusions. Each case is evaluated on individually basis.
