Insurance

This page is also mostly for US patients dealing with an insurance system. At this writing, the US has taken the first tentative steps towards a European-style universal care system, but it will be many years before we complete this transition. In the meantime, patients still have to fight for their health care.

If you have insurance -

Insurance companies are getting better about understanding that Pilonidals are best handled by specialists. Some still want to argue with you, but if you make a big enough stink and keep going up the food chain, you can usually win. Even in countries with universal care systems, patients still have to sometimes fight bean counters for quality care. You must be willing to fight for you health, that is the sad bottom line. You must be relentless in your demand for proper treatment from a provider who knows what they are doing. Nobody else is going to fight this fight for you.

Never take no from a front line person answering the phone. Ask for a supervisor, then ask for the supervisor's supervisor, if necessary. Be nice, but firm and don't give up. Keeping reminding them that YOU are PAYING them for coverage. Remind them that it is in their best financial interest to get your Pilonidal resolved the FIRST time, rather than the insurer paying for 4 additional surgeries.

There are a number of great articles on the web for taking on your health insurer, we link to a small sampling of them below:

http://articles.moneycentral.msn.com/Insurance/KnowYourRights/HowToFightYourHealthInsurer.aspx

http://articles.cnn.com/2007-07-19/health/patient.insurance_1_health-insurance-parents-appeal-medical-bills?_s=PM:HEALTH

http://www.ehow.com/how_2257383_fight-health-insurance-company.html

Getting your surgeon to adopt Cleft LIft- surgeons sometimes are hesitant to adopt advanced procedures because they don't know how to bill for them (and billing is what drives so much of modern medicine.) The CPT codes that apply to Cleft Lift are below, your doctor's office will know what these are and what to do with them.

10080 Incision & Drainage of Pilonidal; Simple (Lancing)
10081 Incision & Drainage of Pilonidal; Complicated (Lancing)
11770 Excision of Pilonidal; Simple
11771 Exicsion of Pilonidal; Extensive
11772 Excision of Pilonidal; Complicated (Pit Picking)
Cleft Lift Codes:

11772

14301

If you don't -

Self Funding -

1) Purchase insurance on your own. This is expensive to the point that it probably won't be worth it in the long run since you will likely have a 6 month waiting period before you can even schedule surgery. If you are looking at a longer time frame, think about one of the new medical savings accounts.
2) Take out a loan. Get your costs from the surgeon's office and take out a small loan to cover them.
3) Charge it. Get a very low interest rate credit card to cover the costs - but don't use it for anything else.

Income Qualified Funding - these are options available to patients that meet low-income guidelines.

1) Check the hospital. Most hospitals have funding available for uncompensated care, but you have to ASK for it and meet their income guidelines. Ask to talk to their patient advocate or social workers.
2) Check with your State's Dept of Social Services. Sometimes they give people temporary coverage who need treatments but aren't covered.
3) Check with the staff at your doctor's office. They may know of programs available to patients of limited financial means.
4) Check into Medicaid.
5) Check with your county health department.
6) Check to see if there is an HRSA Medical Center near you.
http://bphc.hrsa.gov/about/

This page last updated: 12/16/2010

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