Health Insurance Reimbursement
Most of US health insurances reimburse „out of country“ treatment if you apply for the procedure before your surgery. We had patients already being reimbursed from BlueCross BlueShield Association, Aetna, United Healthcare, Medicare and others.
Please apply for the surgery stating you want the procedure performed by the specialists at Adhesiologicum Germany due to their extensive experience with adhesiolysis procedures and high success rates.
Don’t mention anything about SprayShield or gasless Laparoscopy, as both are not approved by the FDA and your insurance might consider them experimental and not cover the cost.
To have you health insurance coverage for Adhesiolysis at Adhesiologicum Germany please consult with your insurance prior to going to Germany to discuss if pre-certification is required for your surgery. Please also read over your benefit and speak with a Case Manager within your insurance company. Not ALL insurances will reimburse, but there is a great chance they do, if you make it very clear how much money they could save covering your adhesiolysis surgery at Adhesiologicum Germany!
It would also be helpful to list all your er visits and / or hospitalizations/surgeries in chronological order. This way your insurance company can fully see in print the amount of insurance usage for your medical condition. It will not hurt to also write a brief letter stating how you became afflicted with adhesions and when you were diagnosed.
Advices from past patients how they got coverage
Betsy Kangas: firstname.lastname@example.org
As far as what we did to get the coverage for my Germany surgery, my husband handled all of that for me. I literally was so sick I couldn’t do it. He called to BCBS ahead of time, we too only had the out of country plan that covered for needing care in emergencies. My husband explained what the deal was, told them the cost ahead of time, they sent us the forms that we first had to fill BEFORE we went, explaining what the cost of surgery was, and what it was for, they came back to us and said they’d cover it. We were thrilled. We first had to pay, and then send them the rest of the forms after we had a invoice to send along with it. Which we then did after we returned home from Germany. It took three attempts (again there’s that three, must be the magic number), they kept saying we needed a more itemized bill, more specific. So together with Dr K, my husband figured out what was needed, calling the insurance company several times to keep clarifying the specifics of what they were demanding from us, and then Dr Kruschinski sent us a detailed, specifically itemized, like the US bills are, with the codes that all along were on his bill correctly (which are on his website), and we mailed it AGAIN! This was almost two years after the surgery itself, and we STILL were having constant issues, they flat out were trying to go back on what they promised. Then, one day my husband came home from work , grabbed the mail out of our mailbox, and came into the house, showing me the check, covering the entire surgery!! I whooped with joy!! Practically knocking him over as I threw myself at him!! I still remember the feeling of amazed delight! We didn’t even dare hope that it would actually happen by this time. Almost exactly two years after my surgery with the brilliant Dr Kruschinski, I got my coverage that was promised beforehand! This was just this past October!! Yay!! So that’s my story! Go look at his website, and the codes on there are what you need to submit, which he’ll have on your bill, and he just needs to use a more detailed bill for those of us in the US. The biggest thing is you have to get them to say they’ll cover it ahead of time. Key. That’s how we did it!
Advices from past patients how they got coverage
Denise West; email: email@example.com
When I initially requested coverage for Charla’s surgery upfront, I was told that I would have to wait until AFTER her surgery then submit an itemized bill for reimbursement consideration. I made the mistake of mentioning the Spray Shield, which is not FDA approved. BCBS US balked as they can’t authorize anything that is not FDA approved or is not approved on a trial basis. NOTE: DO NOT MENTION SPRAYSHIELD. Nevertheless, they did cover it in the claim because it is considered approved in Germany where the surgery took place. They wanted full and complete medical records. DO NOT ASK DR. K’s OFFICE TO TRANSLATE THEM INTO ENGLISH FOR YOU! Send them exactly as you receive them in German. It sounds crazy but for some reason, they expect everything in Germany to be submitted in German. INCLUDE COPIES OF ALL PICTURES FROM ALL SURGERIES IN YOUR INSURANCE PACKAGE. This flipped the script in Charla’s case. Whoever saw the pictures approved the reimbursement immediately. FORMAT ALL RECEIPTS BY DAYS. MAKE SURE THAT YOU EITHER DO NOT INCLUDE COMPANION FEES WITH YOUR RECEIPT OR YOU ACTUALLY UNDERSTAND THESE CHARGES ARE FOR COMPANION ACCOMMODATIONS. They will disallow the companion charges anyway. The biggest problem with BCBS is that they want a copy of EVERYTHING, even the nurses notes and discharge papers. Beyond that, it was the waiting factor as so many parties had to validate the records before they cut the check. AGAIN, THE PICTURES MADE OUR CASE. Once BCBS got the pictures, the approved the application three days later. Hope this helps. If you need further info, feel free to inbox me.
Referral / Recommendation Letter
Here is what you can take to your GP / doctor to sign or write as a referral / recommendation letter:
To the health insurance company.
Your patient has recurrent abdominal adhesions, a so called “Frozen abdomen” with past history of multiple surgical procedures, extensive usage of pain meds and other drugs, psychotherapy and inability to work. The patient might even be in danger of an intestinal obstruction which is an emergency condition.
Patients with severe and reccurent adhesions require an inpatient procedure coded by DRG 335 (Peritoneal adhesiolysis with MCC, codes 44005, 44180) with a lowest cost of $24,914. Adhesion specialist’s here would charges also much higher!
For the condition of severe adhesions and a “Frozen Abdomen” the surgeons at Adhesiologicum Germany are best qualified due to their ability and expertise to treat such conditions with high success rate and a very low complication rate due to their extensive experience in laparoscopic adhesiolysis.
And most important, the cost for this procedure at Adhesiologicum Germany is only $11,600 and allows your insurance company to save at least 55%.
In the year 2005 there were 351,777 adhesiolysis-related hospitalizations with 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion.
(Sikrica et al., The inpatient burden of abdominal and gynecological adhesiolysis in the US, BMC Surgery 2011, 11:13
You can greatly decrease costs for the US health system by approving the adhesiolysis procedure at Adhesiologicum Germany.
Inpatient burden of abdominal and gynecological adhesiolysis in the US
This is one of the newest publications for the cost review of adhesiolysis related costs in the US.
“Inpatient burden of abdominal and gynecological adhesiolysis in the US”
Adhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).
Hospital discharge data for patients with primary and secondary adhesiolysis were analyzed using the 2005 Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. Procedures were aggregated by body system.
We identified 351,777 adhesiolysis-related hospitalizations: 23.2% for primary and 76.8% for secondary adhesiolysis. The average LOS was 7.8 days for primary adhesiolysis. We found that 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion ($1.4 billion for primary adhesiolysis; $926 million for secondary adhesiolysis). Hospitalizations for adhesiolysis increased steadily by age and were higher for women. Of secondary adhesiolysis procedures, 46.3% involved the female reproductive tract, resulting in 57,005 additional days of care and $220 million in attributable costs.
Adhesiolysis remain an important surgical problem in the United States. Hospitalization for this condition leads to high direct surgical costs, which should be of interest to providers and payers.
The inpatient burden of abdominal and gynecological adhesiolysis in the US
Sikirica et al., BMC Surgery 2011, 11:13