Frequently Asked Questions Regarding Insurance

Frequently Asked Questions Regarding Insurance

Understanding your insurance benefits can be overwhelming. There are so many types of insurance and insurance companies, which can make it hard to understand. This document is designed to help our patients understand how insurance works for out of network providers at The CENTER for Advanced Facial Plastic surgery and The Facial Paralysis Institute.

Does Dr. Azizzadeh take insurance?
The physicians at The CENTER are out of network providers with insurance companies. If your insurance has out of network benefits and you have a medically necessary condition then we can discuss with your insurance carrier to see if they can help pay for some of the surgical costs. If you are not sure if you have out of network benefits, you can find out by calling the 1-800 number on the back of your insurance card.

I have good insurance, they cover at 100% and have always been very successful with other procedures and surgeries I have had.
All insurance companies are different. Once you have decided to proceed with the physician at The CENTER we can contact your insurance carrier and determine your eligibility, out of network benefits and deductibles.

What is an allowed amount?
An allowed amount is a dollar amount given to each procedure; this is determined by your insurance company and is based off an average of the procedures in a given zip code. Every procedure has a CTP code, which your insurance company uses to distinguish the procedures.

If the doctors at The CENTER bill more, then shouldn’t you get a higher reimbursement rate from my insurance?
No. Insurance companies have proprietary ways of determining payments. Theoretically, they should reimburse usual and customary rates but this is not always the case.

Can you tell me exactly how much I will get back from my insurance?
No, payment from insurance is never a guarantee. If you call them and listen to their disclaimer it clearly states that the approval is never a guarantee of payment, therefore it is impossible for us to tell you exactly how much you will receive back from your insurance. In many cases your insurance company will not give us the allowed amounts for each CTP code. At The CENTER we are more than happy to give you the possible CTP codes that we may be using during your surgical procedure, along with the diagnosis code.

Many patients have been successful in finding allowed amounts from their insurance carrier since they are their paying customer. However, please remember that codes can change during surgery and that there is no guarantee of payment.

Does my insurance cover the operating room and anesthesia?
For medically necessary procedures, the operating room and anesthesia can bill for those procedures, however you will be responsible for any copay or deductible amounts. We mostly use the La Peer Health Systems surgery center, which is out of network, and Cedars Sinai Medical Center. Please contact them to get more in depth information.

La Peer Health Systems: 310.360.9119

Cedars Sinai Medical Center: 310.423.3277

What is a deductible?
A deductible is the amount a patient pays in full before they receive any benefits from an insurance company. For example, if your medical bill was $1,000, and you had to pay a $200 deductible on your insurance plan, then you would pay the first $200 and your insurance company would pay a percentage of the remaining $800 of the bill. Depending on your contract, deductibles renew every year for most plans.

Most PPO plans (Preferred Provider Organization) insurance plans have out of network benefits for physician facilities that are not contracted. If your plan does not have out of network benefits then we are not able to utilize your insurance to help pay for your medically necessary procedures.

Can you bill my insurance for my Rhinoplasty and my Septoplasty since I will be in surgery for the whole procedure? Can’t they just pay all of the operating room and anesthesia fees?
No. The physicians at The CENTER will only bill insurance for the medically necessary portions of the surgery. The physicians as well as the surgical centers, hospitals, anesthesiologist, etc. will bill the patient separately for the cosmetic portions.