Has anyone been successful in getting bottom surgery at the Suporn Clinic covered by their insurance?
If so, please share your experience here. My insurer has rejected all claims from the Suporn Clinic because of how they do invoicing and I'm wanting ideas on how to fight this.
Okay so I have an update on this for anyone who's interested: OHIP cannot cover the surgery without the itemized breakdown of costs because the bulk charge from the clinic includes uninsured services (like the rides to and from the airport, and other things). I'm trying to see if it's possible to still work around this, or even if the Suporn Clinic is willing to estimate these costs, and if OHIP would be willing to accept that. However, this likely means that even if OHIP ends up covering Suporn, it won't be 100% of the cost, as the clinic will still charge the portion of the bill that OHIP won't cover.
This also makes me more understanding of why the clinic can't provide the breakdown: their fixed price includes a bunch of auxiliary non-medical services that they likely don't even know the cost of, and they probably don't want to risk making a wrong estimate that could put them in legal trouble.
You are an angel. I love this. Thank you for adding to the (on-going) investigation. ❤
Is that still with OHIP? Seems you've reached a complete empasse with OHIP absolutely refusing to process your claim without an itemized invoice, and Suporn Clinic absolutely refusing to make up such an invoice for you.
Suporn Clinic has no reason to help you with this (and multiple reasons not to), so I think you'll have better luck with OHIP. Since coverage isn't an issue and this is just a procedural deadlock, I think all you can do at this point is appeal for an exception to their normal process. Then keep escalating the appeals process until you run out of appeals, and then either cut your losses or hire a lawyer.
Why do you say the Suporn clinic has multiple reasons not to? I'm in this position as well so I don't want to pressure the clinic if it'll actually work against me.
Thanks for this. I haven't gotten that far with it yet but your suggestion is sensible.
This post was created to see if any people, maybe under different insurance providers, handled such an issue. Suporn Clinic is my preference for bottom surgery and I plan on pursuing coverage for surgery with them as far as I am able to take it (the goal being to see it through to coverage - obvs).
"because of how they do invoicing"
You need to find out what the issue with the invoicing is.
Are they using the correct CPT codes? That's a big one that will get any claim rejected without even reviewing it further.
They say it's because they don't have a breakdown to itemize costs (ie: operating room fee, anesthesiologist, surgeons fee, etc.).
The Clinic doesn't account for their costs with this level of transparency because it's not required for them under Thai laws.
Bummer.
If your insurance is requiring an itemized invoice it sounds like your only option is to get the clinic to generate one.
My surgical claims just say things like 'facility charges' or 'surgery'.
The CPT code usually covers what that code involves though without having to itemize on the bill. It sounds like they want an itemized list so they can pick and choose what a 'reasonable and customary' fee is for that service.
Yes, that's how it seems.
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The thing is, many people have been covered by OHIP for bottom surgery in Thailand; the precedent has been set and theres help available where I live to be successful in seeking coverage.
The main issue with getting the Suporn Clinic covered is invoicing. A non itemized invoice is the reason OHIP quotes for rejecting coverage with them.
I think it’s all with Kamol and they seem very business oriented, while Suporn is the opposite.
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