We are very excited to announce our most innovative program enhancements yet! All changes will go into effect January 1, 2017. Full details are listed below, but please make time to attend one of our webinars for more in-depth information.
Capsular Contracture of breast implants placed for primary augmentation will be a Covered Complication.
Coverage Requirements for Capsular Contracture
- Coverage applies only to patients undergoing primary breast augmentation.
- Patient must be diagnosed with Baker 3 or 4 capsular contractures within 18 months of the original surgery date.
- Patient must have the necessary surgical treatment for the capsular contracture completed within 24 months of the original procedure.
- The planned surgical treatment must be pre-authorized by CosmetAssure in order to approve the coverage. Clinic notes, original operative note, pertinent imaging studies, and photos of the patient are required to evaluate the request for coverage.
- Benefit will be paid in excess of any other insurance payments or payments made by an implant manufacturer.
- There is no coverage for complications occurring as a result of the treatment procedure, unless registered separately with CosmetAssure
Medical Expense Maximum Limit for Capsular Contracture
The surgical treatment of capsular contracture (typically a capsulectomy) is covered as an outpatient procedure with a base limit of $2,500, plus any unused Emergency Medical Expense up to a total maximum limit of $3,500.
Online Claims Submission
In an effort to streamline the claims process, we are giving you the ability to submit claims electronically. When a complication occurs, logon to CosmetAssure Member Services (CMS) to report the claim and submit documentation online.
Procedures performed prior to 1/1/17 will be processed by Gallagher Bassett. Procedures performed on or after 1/1/17 will be processed by Intercare. All claims should be submitted through CosmetAssure Member Services (CMS) no matter the date of procedure.
This technology, along with our new claims adjuster, will improve claim processing time allowing for faster payments.
We are proud to partner with Lone Star Alliance, Inc., a risk retention group (LSA). LSA provides medical professional liability insurance to physicians, dentists, allied health care professionals, and groups nationwide. LSA is operated by Texas Medical Liability Trust (TMLT). TMLT, a health care liability claim trust governed by a physician board, is the leading provider of medical professional liability insurance in Texas. Both LSA and TMLT are rated A (Excellent) by A.M. Best Company.
By partnering with LSA, the CosmetAssure policy will no longer be filed as a surplus lines policy. This means that the surplus lines tax is no longer applicable and the policy premiums are now flat amounts across each tier. Please log on to CosmetAssure Member Services (CMS) and click Profile to view full details of your new policy.
Automated Patient Registration
We are in the final stages of developing an automated feature designed to replace the manual process of registering patients. Stay tuned for more information!