Insurance letter

[Danny]

Hello, just got a letter of approval from insurance company, and was wondering if anyone can translate what this means? For procedure description, it says (Ascending aorta graft, with cardiopulmonarybypass, with or without valve suspension). Any feedback would be appreciated. Thanks.Danny

 

[TenPly]

Not sure what "...with or without valve suspension" means, but an ascending aorta graft is basically an aortic prosthesis -- tubing that replaces a portion of the aorta, which is generally used for people who have aortic aneurysms.

cardiopulmonary bypass is also referred to as a "heart-lung machine." It takes over the heart and lung functions during your surgery.

 

[Lynlw]

What do you plan on having done? It looks like to me, you will be having your ascending aorta replaced, and the surgery will need to have the heart lung machine and you may or may not having your valve replaced

 

[Danny]

Thats kinda what i thought.... i have a dilated aortic root, and the surgeon said he more than likely can save the valve. But he wont know until he goes in.

 

[catwoman]

Danny:

I'm sorta confused, that the patient gets a letter of approval. Maybe this is standard now.
However, I thought it was the hospital & surgeon who got the letters of approval (or whatever) from the insurance carrier.

 

[Danny]

Im not sure how it works...My wife walked in and handed me a letter from the mailbox...and it was from the insurance company. Maybe the surgeons office got one too, but i got it also. I was just curious as to what it meant?

 

[Lynlw]

Im not sure how it works...My wife walked in and handed me a letter from the mailbox...and it was from the insurance company. Maybe the surgeons office got one too, but i got it also. I was just curious as to what it meant?

It should have a CC at the bottom that lets you know who all got copies of the letter.

 

[Danny]

Yep Lyn, its copied to the surgeon also.

 

[Cozycat]

That way it makes it easier for both you and the surgeon. No questions about what or what not the insurance company is allowing. More companies should do this.

Midge

 

[Ross]

Hello, just got a letter of approval from insurance company, and was wondering if anyone can translate what this means? For procedure description, it says (Ascending aorta graft, with cardiopulmonarybypass, with or without valve suspension). Any feedback would be appreciated. Thanks.Danny

Danny it's kind of open ended. They're saying they are expecting aortic graft, you'll be on bypass with the possiblity of valve repair or replacement.

 

[swim mom]

I always get a copy of the approval along with the doctor

 

[Lisa in Katy]

The member should get a copy of all correspondence. This includes approval and denial letters and explanation of benefit letters.

This is the verbage for CPT code 33860. Valve suspension does not mean replacement. Suspension is done with a ring or sutures. If they replace the valve, they will use a separate code for aortic valve replacement. FYI, Medicare reimbursement for this code in 2009 is $3088. This only includes the surgeon, of course, as hospitals don't bill with CPT codes and the anesthesiologist will use a different code.

 

[jax]

I know I got a letter of approval from my insurance company also. They send me copies of everything. If I go to my family doctor and pay my copay about a month later I will get a form stating what they covered and what they didn't. And it will say this is not a bill. I like getting all of these forms because if there is a dispute over something I can have something in front of me when I call the insurance company.

 

[Jkm7]

I received my 'letter of approval' after my surgery was completed and the day after I got home.

I'm sure the surgeon and hospital knew insurance had approved or probably would have had conversation with me in advance of surgery if not. In the four weeks between setting my surgery date and my being admitted, I'm sure all seeking payment were getting approval. I never personally had any conversations of any sort with my insurace involving either of my OHS. I had one bill for $5 when all was said and done. Grateful we have such good insurance.

 

[Danny]

Thanks for all the input on this.

 

[terodac]

All hospitals make sure they will get paid for this surgery some do not pay for all of it. Your Blessed that you have good insurance that will pay for it mine did and my out of pocket was not much from the total price of $250K. It means you are on the launch pad Danny! Good Luck, when is your surgery?

 

[Danny]

Surgery is on the 13th of this month.