Health Insurance and Microtia Surgery

Most insurance companies do not care about you or the quality of your microtia surgery outcome. Their concern is in maximizing profits. They want to collect your premium and spend as little as possible. How do they do this? 

First, they will try to classify microtia reconstruction as cosmetic surgery. It is definitely not! Cosmetic surgery is taking something that is normal and trying to make it better than normal. Reconstructive surgery is taking something that is not normal and trying to make it normal.  We have never lost an insurance appeal due to this trick.

Second, they will want you only to see their in-network physicians. They are really not concerned with the quality of your surgical reconstruction but rather meeting the requirements of your insurance contract with the minimum cost.  They will provide you with a long list of other plastic surgeons in your network.  If you were to call each surgeon's office their response to your inquiry usually is "How do you spell Microtia?"  Your insurance company will tell you that if you choose one of their in network doctors you can avoid excessive out-of-pocket costs. This is one of the biggest concerns of families who contact our office inquiring about microtia reconstruction. They may have contacted their local doctors and were not happy with the results that they saw. They may have contacted national or international specialist only to find out that their out-of-pocket costs were between $20,000 and $40,000. These families feel overwhelmed and powerless in fighting the Goliath insurance companies.

Dr. Griffiths believes your insurance company is near sighted in believing that they can control costs by sending you to a less experienced surgeon in their network.   Sending you to a contracting surgeon for a discounted fee may save them a little but they lose heavily on the giant hospital bills created by multistage microtia reconstruction techniques as well as by the multiple future revision surgeries.  

Dr. Griffiths’ office has a significant amount of experience in working with insurance companies. There is a chance he may be out of network for your particular health insurance, however you may be surprised, his out of network status may work in your behalf.  If you have encountered any of the problems mentioned above with your particular insurance company, please contact our office and I am sure that we can help you. There is no reason why you should have to pay any more out-of-pocket other than your maximum out-of-pocket listed for your individual policy. Most of our patients pay less than $2,000 for their entire ear reconstruction.

Most patients rely on our office to do most of the work with their health insurance company.  If you do call and talk to a representative from your insurance company, please remember to document every conversation that you have including both the first and last name of the person that you are talking to, and the date and the time that you talked to them. If you do not have it in writing from the insurance company, to them it did not happen. If you receive a favorable answer over the phone, please verify it with a letter back to that person stating “It is my understanding from our phone call dated ____ that you are approving coverage for microtia surgery with Dr. Griffiths. If this is not the case please write me back within 10 days.” Every piece of documentation that you send to the insurance company should be sent with delivery confirmation receipts. Be patient because this can take a while. Insurance companies will often prolong the process as they drag their feet. Remember persistence pays off.  Also, locate the name of your state insurance commissioner as well as your local, state and federal government representatives. Please do not get discouraged. Remember that insurance companies often care more about their year-end profit than about the health of your child.

If you have questions about health insurance and microtia surgery, please contact us today.