Covering The Cost of Complications

Sep 14, 2022 at 07:21 am by steve

James C. Grotting MD

She had done her homework and found a board-certified plastic surgeon she trusted. Since the elective procedure wasn't covered by her health insurance, it had taken a while to save enough to pay for the surgery, but finally the big day came.

The procedure went well, and it looked like the investment she had made in herself was going to pay off in great results that would boost her confidence and self image. But when she was in recovery, her plastic surgeon noticed that something unexpected was going on with her blood pressure.

"In some patients--few, fortunately--there can be an unusual response to anesthesia. Blood pressure that was normal before surgery can suddenly rise to dangerous levels and stay there." James Grotting, MD said.

One of the foremost plastic surgeons in the country, Grotting has served as president of the American Society for Aesthetic Plastic Surgery, is chairman elect for the American Board of Plastic Surgery and has taught the specialty at two major medical schools. Yet even he, despite his highly regarded skills, has had to deal with the unexpected. And in the real world, when dealing with anything as complex as the human body, the unexpected can happen any time.

"In this particular case, the patient's blood pressure was still far too high to send her home," Grotting said. "She needed to be monitored closely for a day or two until her blood pressure returned to normal. But the cost of inpatient care would be a lot for her to have to pay out of pocket since health insurance generally doesn't pay for anything that could be related to an elective procedure. I felt really bad for her. She had already paid for her surgery. She was going to be happy with how she looked, but no one would be happy facing a large unexpected bill.

"Fortunately, at the time I was teaching at a medical center and was able to arrange for her care at no charge. But the incident got me thinking--how would other patients deal with this kind of expense? Would their surgeons have to share in the cost or face a lawsuit? I was active in professional organizations and knew this would be an issue of concern for most of our members. I also knew people in the insurance field and started talking with them about the possibility of insurance for complications of plastic surgery." That led Grotting to launch CosmetAssure almost 20 years ago.

Today CosmetAssure coverage protects a large percentage of board certified plastic surgeons and their patients across the U.S. In addition, the information gleaned from the insurance provides a database of all covered elective procedures performed over almost two decades, detailing risks associated with various types of plastic surgery, as well as the most likely complications associated with different procedures, which helps patients make better informed decisions and alerts surgeons to potential complications.

Available through the Birmingham office of USI Insurance Services, one of the leading privately held insurance brokers in the country, the coverage was the first of its kind in the U.S.

"To apply for coverage, a physician must be a board certified plastic surgeon and a member of at least one of two professional organizations, either the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery," said Amy Fuqua, a Senior Account Executive with CosmetAssure. "The insurance covers treatment for complications that arise within 42 days of the procedure or possibly longer in rare conditions that take more time to become apparent.

"The most common claims are related to relatively minor complications; for example, hematomas and occasionally infections at the surgical site that may need more aggressive treatment. Depending on skin type and how well post-op care instructions are followed, some scars may be more noticeable than others and require revision or other follow-up."

Grotting said: "when the idea first came to me, I was thinking of something like travel insurance. Patients could choose to opt in or opt out. But after discussing it with insurance industry friends, it made more sense to insure all procedures so costs could be spread out over a larger number of people. If only the most at-risk patients chose insurance, the cost would be too high to be practical. Spread out over all procedures, the cost could be quite low and the same for all procedures. The only exception is the Brazilian butt lift. There's more that can go wrong, so the premium on that procedure is higher. Some plastic surgeons add the premium to their bill as a line item, but I just build it into the basic cost.

"It's a relief to know that we now have insurance for complications for all our patients. We don't have to worry about them having to cope with unexpected bills. We can do our work and concentrate on giving them beautiful results."

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