Insurance / Surgical Coordination

INSURANCE COVERAGE

Dr. Mary Shinn is NON-PARTICIPANT with all insurance companies. You must have out-of-network benefits.

Verify with your insurance company that you have OUT-OF-NETWORK BENEFITS. Confirm your annual deductible and your co-insurance responsibility, which is a specified percentage you are responsible for after your deductible is met.

HMO’S and Medicare are not accepted.

DOCUMENTATION FOR INSURANCE APPROVAL

For patients having a breast reduction, insurance companies require documentation showing back, neck or shoulder problems. Please obtain your doctor’s office notes as well as a letter from your doctor recommending the surgery, if possible. You must obtain office notes showing the dates that you have been to your doctor as well as any treatments prescribed or recommended. If your current mammogram report is available, please bring it with you as well.

For patients having body contouring after massive weight loss, your insurance company requires documentation showing that you have been under care for intertriginous dermatitis (rashes, sores, irritation between skin folds). Please obtain office notes showing dates that you have been to your doctor for treating your skin condition as well as a letter of medical necessity from your doctor stating that it is medically necessary for you to have your excess skin removed, due to intertriginous dermatitis.

If you have been prescribed NSAIDS for your back, neck, or shoulder pain, as well as, creams, ointments or medications to treat rashes, sores or skin irritation, you must obtain that documentation from your doctor clearly stating the name of the medication and how you responded to it. Many insurance companies require at least 6 months of documented therapy.

Once all the information is submitted to us we will contact your insurance company and begin your pre-certification process. This process may take 6 to 8 weeks. Insurance approval is not a guarantee of payment. We will not know exactly what your insurance will pay until after the surgery is done.

We will coordinate your surgery after the pre-certification process is completed and approved. You will be required to pay your deductible and a portion of your co-insurance at the time your surgery is scheduled.