For insured patients, Mr Gault’s consultation fees, surgical fees and follow-up fees are rarely covered in full by most insurance companies because of a reduction in the level of reimbursement. BUPA and Aviva members in particular should be aware that current reimbursement may be less than with other Insurers, and that there is usually a considerable shortfall which is payable by the patient. Axa PPP members should be aware that the insurer does not pay for follow-up fees if the appointment falls within ten days of your surgery.
There may also be an excess on your policy, or specific exclusions. Surgery for aesthetic (cosmetic) reasons is usually excluded, for example. Laser treatment to treat difficult ear cancers in combination with conventional surgery may not be covered. You will be asked to settle any shortfall and we strongly advise that you check that you have authorisation from your Insurer for the procedure you contemplate together with benefit maxima. Your insurer may ask you for an code to indicate to them the type of procedure you are considering, and we are always happy to help.
The applicable CCSD codes for ear reconstruction include: D0310 ear reconstruction including graft, T0320 Exploratory Thoracotomy, T0810 Resection of Rib, S3620 Full Thickness Skin Grafts and S2400 Large Local Flap). However, there is no code for multiple complex Z-plasties, carving of the cartilage framework from rib segments, nor for framework assembly, which doubles the procedure time.
Many insurance companies, such as BUPA, PPP, and WPA have designated the procedure of special complexity, to enable reimbursement of fees in full. We would emphasise, however, that such authorities are awarded on a case-by-case basis, and are often strongly resisted by certain Insurers.
There may also be an excess on your policy, or specific exclusions. We respectfully request that you settle the fees in full pre-operatively and request reimbursement from your Insurer, if applicable. For detailed information on the surgical procedures involved, we recommend that your insurance company advisors consult the following seminal texts: