Insurance & the Nuss Procedure

The Nuss procedure is a surgical procedure which is used to help people with pectus excavatum deformity syndrome--a congenital birth defect which causes the ribs to grow abnormally and appears as a sunken sternum. In the Nuss procedure, a large curved bar is inserted on the chest wall. The symptoms for this disease include continuous fatigue, a low immune system and inability to exert oneself physically. These days, insurance companies generally provide reimbursement for the Nuss procedure.

Insurance Policy

• Before you schedule your child for the surgery, check with your insurance provider to find out whether they will pay for it. If at first they deny, recheck your policy and consult with your insurance representative before taking their answer as final. Even if the insurance company agrees to pay, it is important to determine what portion of it you will have to pay from your pocket. Get an estimated cost for the whole procedure from the hospital.

Preapproval

• It is always better to get preapproved for the Nuss procedure, even though it is likely to be approved. Nowadays, insurers rarely deny paying for the Nuss procedure because it is an agreed-upon fact that it is a congenital birth defect. As recently as the mid-1990s, the scenario was different, with insurers considering the Nuss procedure a cosmetic surgery and usually denying the insurance.

Precautions

• Some insurance companies insist on a surgical authorization. If they require this document, request one from your surgeon's office. This process is time-consuming and might take several days. Hospitals generally assist policyholders by producing all the required documents--from medical reports to surgical approvals--so that the insurance companies can coordinate with them for the payment. It is better to plan the surgery a minimum of 45 days in advance to better deal with any insurance problems beforehand.