My insurance does not require referrals. Also, my insurance company could not tell me whether they’d cover this or not until they received a predetermination of benefits letter from Dr. Haney’s office. In the end, my TAC surgery cost only my $100 surgical copay as I had already met my out of pocket max for the year.
Also, if you do not have insurance coverage, then you should consider contacting Dr. Davis’s office because he has a plan in place where he offers the TAC at cost – last I heard, this was around $4k. [UPDATE: that was when Dr. Davis was in New Jersey. I am unsure whether he offers the same cash price at his new practice in Tennessee.] I believe Dr. Haney was also working on something like this, but I’m not up to speed on that latest information.
This is a copy of information I received from Dr. Haney’s office:
Regardless of your insurance plan, you should immediately contact both your Primary Care Physician (PCP) and your insurance company to let them know that your surgery has been planned. Ask your PCP to fill out a referral form and submit it to your insurance company. The PCP will need the following information:
–ICD-9 codes: 622.5 (diagnose code)
–CPT codes: 58999 (procedure code)
–Anticipated length of stay: 23 hours
RE: EXPLANATION OF THE USE OF THE 58999 CPT CODE FOR PLACEMENT OF A TRANABDOMINAL CERCLAGE PRIOR TO PREGNANCY
The purpose of this letter is it to provide for the rationale for using the CPT code 58999 to describe the surgical procedure when placing a transabdominal cerclage for an incompetent cervix. The procedure performed is placement of a transabdominal cerclage prior to becoming pregnant. The CPT code utilized is a 58999, e.g., “Female Genital System Procedure”, which is typically used when describing an unlisted gynecologic procedure.
The ICD-9 code for an incompetent cervix when pregnant is 654.53 and 622.5 when not pregnant. The CPT code for placement of a transabdominal cerclage during pregnancy (typically between the 10th and 14th week of pregnancy) is 59325. There is no CPT code for placement of a transabdominal cerclage prior to pregnancy, hence the use of the unlisted “Female Genital System Procedure” 58999 CPT code. The procedure requires a laparotomy, spinal or general anesthesia, placement of a 5 mm Mersilene band immediately beneath her uterine arteries surrounding the cervix and an over-night hospital stay. The general risks are comparable to any gynecologic laparotomy for benign disease.
This should adequately explain the use of the 58999 CPT code when placing a transabdominal cerclage prior to pregnancy.
If your policy does not require a referral form from your PCP (most PPO’s do not), contact your insurance provider and inquire about pre-certification policies/procedures. It is vital that you follow all of your insurance provider’s guidelines. Failure to do so puts you at risk for having your procedure denied, and puts you at risk of being responsible for the bill. It is better to postpone the surgery than to have your insurance provider deny payment and send the bill to you because their administrative procedures were not followed. We are more than happy to help you to navigate through your insurance provider’s process, but ultimately we cannot do it for you.
Thank you for taking the time to provide this information!
Absolutely! There is also a new folder on the Abbylooper’s board with a TON more insurance info, including, I believe, one solid appeal letter that just can’t be denied. It has tons of medical study references.
How do I get accepted into abbyloopers? It states still waiting for approval
Mmmm…are you on the Abbyloopers’ Facebook group? I would tag Marcy Lynn and ask her to please approve your Abbyloopers’ entrance. If that doesn’t work, find me – Kathryn Nguyen – on FB, and I’ll see if I can get her.
Kristi, I don’t know how I missed this. If you haven’t gotten in yet, please email me at firstname.lastname@example.org!
I’m have the same problem I been waiting for my approval but I never got it. I tried facebook the forum. I’m so sad.
Miru, were you able to get in yet? If not, please email me at email@example.com with your name and email you applied to Abbyloopers with!
Hi! Did you have to ask for the letter or did Dr. Haney’s assistant automatically do it for you? I’m nervous to schedule any flight plans and I am told they won’t check my insurance until 30 days before the surgery. My insurance said they would need a letter.
I just contacted his assistant, and she took care of everything. It WAS scary waiting, but I also had the luxury of waiting to book my flight until it was approved.
I cant thank you enough for this information!!!! I just sent the codes over to my insurance. Aetna PPO. I just hope I don’t require a failed TVC before they will cover my pre-pregnancy TAC. Fingers and Toes crossed!!!!! My surgery is scheduled with Dr. Haney for Feb 2015 (it cant come any sooner) I’m just waiting for confirmation on the time. 🙂 Thanks again!!!
Absolutely! Be sure to jump on Abbyloopers, too, because they have tons more info and can help walk you through any specific issues!
Hi. Does Medicaid in Florida cover TAC
Jennifer, I’m not sure about Florida, though I have seen it covered in other states…even going out of state if no TAC surgeon was available in that state. That’s the extent of my knowledge on it, though. Definitely join Abbyloopers.org and the Abbyloopers Facebook page and somebody there will be in Florida and know for sure!
Tes, did you have your surgery yet? How’d it go?
Hi There 🙂 its scheduled for Feb 20th. I cant believe the day is almost near! and thankfully my insurance will cover it!
Almost time!!! I’m so excited for you!
Thank you for this information! I’m nervous about insurance covering my TAC. I have Aetna POS II and am scheduled to have surgery 12/9 by Dr. Haney.
You’ll do great! You couldn’t be in better hands and he will definitely help with insurance!!
OH MY GOSH!!!! THANK YOU SO MUCH FOR THIS!!!!!!! I have been on the phone with my insurance for forever because the CPT Code: 58999, is what my insurance calls a “dump code” meaning, there is not enough info. on the procedure, so I sat and explained what was going on, what happened, and the steps I am taking to prevent myself from ever losing a child again…. A.) I have blue cross blue shield, Preferred Blue PPO/EPO B.) Dr. Haney is within my network “Thank You Jesus!” C.) she told me that the CPT Code: 58999 for the TAC prior to pregnancy was NOT the correct code and it would get denied…. So, I quick went to my bookmarks, pulled up your page and threw the TAC during pregnancy code at her and BINGO, that worked… she said it didn’t matter, if it was done before or during pregnancy, they need a code that explains more in detail what is going on. Thank You so much, if I had not studied your page for 3 days, I would have not known what to do and she said she couldn’t give me the code either, the provider needed to do that!!!! You have been such a blessing to me and you don’t even know it!!! All your info has been spot on and so helpful!!!
I’m so glad this helped!!!! And, there is a HUGE insurance file on Abbyloopers, so definitely check out that file!