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Is my surgery considered medical necessary? Will insurance pay for my surgery? Can I get disability for time off?

The term medically necessary is an insurance term from either health insurance or disability insurance companies. This is not a term medical professionals routinely use as part of their care. Elective surgery describes surgery that is scheduled in advance and is not of urgent nature. Examples are a hernia repair, joint replacement or breast augmentation. Surgery for an urgent medical issues like appendicitis or after trauma, is not elective. Cosmetic surgery is surgery that deals with aesthetics and is usually elective. Complications of elective surgery and/or cosmetic surgery can, however, become urgent medical issues.

Bancroft Feldman Plastic Surgery does not accept medical insurance for any cosmetic surgeries. However, some patient’s may try to request time off under their short term disability insurance program.

Your insurance company will argue your surgery is not medically necessary, and you believe it may be. Many insurance companies have pre-existing exclusions, or documented guidelines regarding cosmetic surgery and/or complications of cosmetic surgery in your policy. Your policy is a binding contractual agreement between you, the policy holder, and the insurance company. Therefore, this a discussion best had between you and your insurance company, prior to surgery, after thoroughly reviewing your policy. Bancroft Feldman Plastic Surgery is a boutique cosmetic surgery practice, focused on delivering patient care at reasonable prices, not an insurance approval advocate, and therefore, does not have resources available to aid in this process.

Many patients try to put the surgeon or their staff in challenging positions "just say yes when they call!" It seems that easy from the patient perspective, but it's not our first rodeo. "Just saying yes" still may not lead to approval, and could end up creating a long drawn out legal battle, where ultimately that request will be disclosed to all parties and may void any coverage or payment previously approved. Even worse, in the case of health insurance, such a statement could result in a pre-certification being issued for surgery, and then payment denied after surgery, leading to a huge hospital and anesthesia bill completely independent of Bancroft Feldman Plastic Surgery.

Therefore, at Bancroft Feldman Plastic Surgery, the medical records stand by themselves, as both a record of medical care and legal document, and can be requested for review after proper paperwork (and patient approval in case of third party) and payment is submitted. As such, we do not provide any additional opinions, answers to questions or documentation outside of the medical record.