The nasal surgeon has the right to charge a fee—in addition to the surgical procedure fee—for the additional professional service of inserting and later removing the Reltok Clear-Flo Nasal Airway.
Surgeon insertion of the Reltok Clear-Flo Nasal Airway is a separate professional service. It is not integral to the surgical procedure. The airway is not a pack; it is not a splint; it is not a stent. The airway is not being used to influence the outcome of the surgery, as the splints and stents are used. The airway nests distant to the surgically-operated arena.
No need to pre-authorize the Reltok Clear-Flo Nasal Airway
Asking permission of the insurer to pay for new and relatively unknown surgical service, before surgery, is not productive. Their default answer will be “NO”. Nonetheless, when you bill properly, the claim will be honored.
Based on a review of six plus years of experience of how payers handle claims, which includes a separate charge for the airway, our advice is: DON’T ASK FOR PRE-AUTHORIZATION OR PERMISSION FROM THE PAYER. JUST DO THE BILLING AFTER SURGERY. All template samples and forms are available for download on our website.
If pre-auth is needed for the septoplasty or whatever, OK, but you are not obligated to specify, pre-operatively, all the procedures you may do at surgery. That is determined at the time of surgery. After surgery, just bill the case’s surgical procedure(s) and also fill in another line with the charge for the airway. Be sure to include proper text (we provide a template of such) in the op report to support the charge. Then, closely examine the EOB when the payment is made. You learn by studying “what happened” at the insurance processing office. That’s how we learned.
Payers will not automatically cut your fee for the airway
Insurers never “cut” or reduce the charge, as contrasted with the second or third surgical procedure done at the same session.
Dollar payment to the surgeon is determined by the specifics of the insured’s policy. Maybe the policy pays only 50% to a non-contracting MD, or there is a big co-pay that is eaten up by this surgery, or likewise, a high deductible. We have no control over policy specifics. The “allowable” dollar amount for “Insertion and fixation…, CPT 30999-59”, is not automatically discounted as is the case for the actual surgical procedure.