Wondering what to expect to be charged for my upcoming surgeries.
I’ll be having nasal polyps removed from both sides of my sinuses and my deviated septum corrected. Here is the verbiage from my employer’s insurance contract through Highmark:
We Cover Physicians’ services for surgical procedures, including operating and cutting procedures for the treatment of a sickness or injury, and closed reduction of fractures and dislocations of bones, endoscopies, incisions, or punctures of the skin on an inpatient and outpatient basis, including the services of the surgeon or Specialist, assistant (including a Physician’s assistant or a nurse practitioner), and anesthetist or anesthesiologist, together with preoperative and post-operative care. Benefits are not available for anesthesia services provided as part of a surgical procedure when rendered by the surgeon or the surgeon’s assistant. Sometimes two (2) or more surgical procedures can be performed during the same operation.
Through the Same Incision. If Covered multiple surgical procedures are performed through the same incision, We will pay for the procedure with the highest Allowed Amount and 50% of the amount We would otherwise pay under this Certificate for the secondary procedures, except for secondary procedures that, according to nationally-recognized coding rules, are exempt from multiple surgical procedure reductions. We will not pay anything for a secondary procedure that is billed with a primary procedure when that secondary procedure is incidental to the primary procedure.
Through Different Incisions. If Covered multiple surgical procedures are performed during the same operative session but through different incisions, We will pay: • For the procedure with the highest Allowed Amount; and • 50% of the amount We would otherwise pay for the other procedures.
Since nasal polyp removal technically doesn’t require an incision (debrider), would it be covered under a different clause? Or is the use of a debrider considered an incision for legal purposes? Is this considered two different incisions (Deviated septum and polyp removal) or the same incision?
Thanks in advance.