First download the One-Page Checklist and spend some time with it assessing where you are, what you have, and what you need to do.
It is free.
If terms are unfamiliar to you then download the Reimbursement Guidebook. There are dozens of additional documents, sample appeal documents and a library of over 160 research papers.
And I’m not going to be hitting you up later for payment. Surprise! I’m already paid for all of this. (Very well, I might add).
Download the Patient Data Sheet so I have the basics of your claim and status if you want to discuss your claim. I am glad to answer any questions you have but I will assume that you have already read through the checklist, sent me all your basic information (surgeon, address, contact info, insurance company, etc..) and at least skimmed through the Guidebook. You don’t have to read every word unless it interests you (and you might want to further your education in coding and billing).
Since 1992 I have worked in the field of medical coding, billing, compliance and documentation. Mostly education—training certified coders and traveling the country teaching full-day seminars (at your local Holiday Inn). It was the good ole days.
Everything on my website is royalty and copyright free. How cool is that!
One thing you will notice that is unique is that all of our documentation and lists are either posted to a web page (which you can copy and paste) but are also available in Microsoft Word and Excel spreadsheet formats. Once you download the checklist make it your own. Add your unique issues. Add your information and timeline.
I am paid to give it all away! Not only does my sponsor just want to help with reimbursement for liposuction for lipedema—they requested that their name not be on the site. So they are not doing for the good press. Just to honestly help those with lipedema.
I am not a Patient Advocate, per se, but here are examples of tasks I can help with.
Example 1: One patient had a denial that “she did not have lipedema”. I spent 4-6 hours and sent her my reply cutting and pasting from the dozens of sample documents on my website.
Example 2: Another was approved for liposuction of the lower extremities but denied for the upper extremities. That was a new one so I assembled my best research arguments for lipedema of the upper extremities. I also contacted lipedema experts I now have on speed-dial.
Example 3: Another denial was for the common “out of network” issue. Often your insurance company will simply find an in-network plastic surgeon or an in-network surgeon who performs liposuction and recommend them for your surgery. You want someone expert in lipedema. Not every plastic surgeon is skilled in removing the lipedema fat and tissue and the technique and focus are different and the surgery takes longer than cosmetic liposuction.
Example 4: You receive a denial and discover that the determining physician has no experience in either liposuction or lipedema. This is similar to the above except often the physician will not even be a surgeon or knowledgeable about lipedema or liposuction. Educate the carrier that both are very complex, very detailed subjects. Send them y 15-page policy payment with over 50 research citations. Ask how many of the papers have they read. Your expert read all or most of them.
Typically I work requests that allow me to create another document I feel can help dozens more. Then I post it here.
Just understand that my mission is to get everyone paid versus getting any individual patient paid. That difference means that I can afford to work on more global and far-reaching assignments. An example is that I was able to help the team of experts and researchers submit a proposal for specific ICD-10-CM codes lipedema—which will have enormous impact on the awareness, diagnosis, and treatment of lipedema. Our goal is Oct 1. 2021 for the 2022 code set.
In addition I am currently working with researchers to refute papers that hurt our view of lipedema and treatment in the United States (The Five Myths). The up-side is that I get to work with the leading lipedema experts and liposuction surgeons in the world.
So let’s get started and good luck! Use the contact form if you have any questions.
Jeffrey P. Restuccio, CPC, COC, MBA
Reimbursement Consultant