Bring On the Blues!

“Are you contracted with my insurance company?”

That’s always one of the first questions asked by our prospective patients. If your Blue Cross Blue Shield plan is a member of the “Blue Card” network then the answer is “YES” and you can rest assured there will be no surprises and you will get the best benefit available to you through our practice, our chosen hospital, and any ancillary services. We never utilize providers outside of the network for our Blue Cross Blue Shield patients.

100 million members — 1-in-3 Americans – rely on Blue Cross Blue Shield companies for access to safe, quality, and affordable healthcare. Operating and offering healthcare coverage in all 50 states, the District of Columbia and Puerto Rico, the 37 Blue Cross and Blue Shield companies cover 100 million Americans.  Nationwide, more than 96% of hospitals and 92% of professional providers contract with Blue Cross and Blue Shield companies — more than any other insurer.

The Blues® currently serve 85% of Fortune 100 companies and 76% of Fortune 500 companies.  Moreover, the Blues have enrolled more than half of all U.S. federal workers, retirees and their families, making the Federal Employee Program the largest single health plan group in the world.

bluesHow can you tell if your plan is part of the “Blue Card” network?

– Alpha Prefix – Three characters in the first position of the identification number.

– Suitcase Iconee characters in the first 

Here is how the program works:

  • We submit our claim to Blue Cross Blue Shield of South Carolina (BCBSSC)
  • BCBSSC electronically forwards the claim to the patients home plan
  • Patients home plan verifies eligibility, applies benefits, and returns claim to BCBSSC
  • BCBSSC applies pricing according to our contract and sends remittance and payment to us

If you are still uncertain or if your card looks a little different than the sample here, just give us a call and we’ll be happy to check it out for you. We have insurance experts on staff that can answer these kinds of questions quickly and efficiently. Our office is contracted with most major insurers including United Healthcare, Cigna, Medicare, Aetna, Humana, Coventry and many, many more. We’ve never met an insurance company we couldn’t work something out with.


Gail Lanter, CPC

Center for Natural Breast Reconstruction

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

The Affordable Care Act’s Day(s) in Court

The Supreme Court heard arguments about the Obama Administration’s Affordable Care Act earlier this spring, and is expected to hand down a decision regarding the healthcare law any day now. Here’s a look at how various possible decisions could affect the state of healthcare in the United States.

Option 1: The Supreme Court Rules the Affordable Care Act Is Good to Go

The main argument against the Affordable Care Act challenges its so-called individual mandate, which, if enacted, would require all Americans to have health insurance (through the government, employers, or an individually purchased plan). If the individual mandate is given the green light, then…

  • Uninsured Americans will have to purchase health insurance by a certain deadline or face a penalty charged at tax time.
  • Health insurance companies will be required to make insurance coverage available to everyone, including those with preexisting conditions.
  • Low-income Americans (those with household incomes up to 138% of the poverty line) will qualify for government assistance for medical insurance (possibly in the form of Medicaid).

The individual mandate could be good news for women with breast cancer who have been denied coverage or reimbursement for treatment, because it will require insurers to cover them regardless of their current or former health.

But most health professionals, regardless of their political affiliation, agree that the individual mandate is far from an ideal system.

Option 2: The Supreme Court Strikes Down the Individual Mandate

If the Supreme Court rules that the individual mandate is unconstitutional, the Affordable Care Act may be doomed. Without the guarantee that all Americans buy health coverage, there is no incentive for health insurance providers to make coverage available to those with breast cancer and other potentially costly conditions.

Without the individual mandate, the health insurance landscape in the U.S. may remain as it is for the immediately foreseeable future.

More Reasonable Healthcare Down the Road?

Some commentators on the health care hearings have suggested that there might be greener pastures ahead for health insurance in the States. It seems that a dismissal of the individual mandate could, by some analyses, pave the way to a single-payer insurance system, under which all Americans would be covered by the federal government, regardless of job or health status.

While most Americans agree that the current state of health insurance in this country is far from ideal, few understand how important comprehensive coverage is better than those who have had life altering illnesses like breast cancer and major procedures such as breast reconstruction.



Charleston Breast Surgeon Answers Your Implant and Insurance Questions

charleston breast surgeonsThe below questions are answered by Dr. James Craigie of The Center for Natural Breast Reconstruction

Should a woman have an MRI follow up every two years after implants to check on things? I’ve been told this.

Let’s go to the source of that information for the best answer . . .

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants . . .

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic.  Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here:

Does insurance generally cover redoing of nipples and tattooing?  I’m not completely satisfied with the result of my nipple reconstruction procedure.

Great question . . . Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient.  Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up tattoo.

—James E. Craigie, M.D.

How to Maximize Insurance Coverage and Discover the Full Range of Benefits

health insuranceHealth insurance coverage can be confusing, and often patients don’t know what is covered, which can lead to problems and extra expense. Following are three ways to maximize your insurance coverage and get the most for your money.

Premium cost isn’t the only consideration.

Many employers offer only one health insurance policy, but you do have the option to purchase coverage elsewhere. If you choose to purchase privately, look at more than the monthly premium before buying. Plans vary widely in their coverage and total cost, and some will be a better fit with your family’s health situation and desired coverage.

You should consider several things when buying health insurance:

  • Coverage should be adequate for any current health issues, including paying for prescriptions, medical equipment, and services such as physical therapy and nursing care.
  • Pre-existing condition coverage varies, but normally there is a waiting period before insurance will cover those health issues.
  • Deductible is the amount you pay each year before insurance goes into effect. This may be separate from your copayment.
  • Coinsurance is the percentage you pay after insurance kicks in. This typically varies from 10–50%.
  • Maximum out-of-pocket expense is the maximum dollar amount you will pay each year. Once you have reached that amount, insurance pays 100% up to the maximum plan dollar limit.
  • Maximum plan dollar limit is the most the policy will pay. Plans may have an annual and / or lifetime maximum dollar limit.
  • Copayment is the amount you pay at the time you visit the doctor, pick up a prescription, or enter the hospital. This payment may or may not count toward your deductible.

You will also want to check whether your doctors and pharmacies are listed in the insurance company’s network of providers. If they are, your visits and prescriptions will cost less. If they aren’t, you’ll pay considerably more—and some plans will not cover any care given out of network.

Read your policy thoroughly.

It’s not exciting reading, but familiarizing yourself with your policy will avoid nasty surprises and extra cost and hassle later. Speaking of surprises, you might find services and products are covered that you never thought of, such as alternative treatments and over-the-counter medicine.

Insurers send updated policies regularly, so be sure to read those as well, and keep the summary of benefits handy for quick reference.

Double-check your policy before, during, and after you receive care.

Make sure that everything you need is covered by your policy. Check whether you will need referrals from your physician or authorizations from the insurance company before you go in for care. Every insurance company has specific procedures they follow, and straying from them can cost money or time.

Any time you receive care, you need to be proactive about ensuring that your doctor’s office is coding and submitting your information correctly. Afterward, carefully check all bills to see that the insurance company is paying them. Don’t be afraid to talk to the insurance company directly and do what you can to maximize your coverage.

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