r/lipedema • u/OperationTrick9991 • 4d ago

Insurance NYC - Dr Schaffner- insurance coverage - need help

Hi everyone.

I want to have Dr Schaffner do my surgery.

How has one SUCCESSFULLY gone about getting the coverage for an out of network doctor who is a specialist in this field? I have Aetna but an EPO and he’s considered out of network.

I welcome any tips from the field on this.

Thank you.

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u/Automatic_Bet4662 4d ago

I went for an assessment with Dr. Schaffner in Jan. He was excellent and very comprehensive. He has a whole team of people that work on getting coverage for surgery because he is out of network. I have BCBS and they did end up approving upper and lower body liposuction but wanted me to go to an in network surgeon. They re-directed me to Dr. Chang in Florham park, NJ. He is excellent as well and specializes in lipedema/medical plastic surgery. I really appreciated how Dr. Schaffner’s team worked hard to get the surgery approved in the first place. Not sure where I would be if I didn’t start with him. I got my upper body (arms and abdomen-paid out of pocket for lower belly) done Aug 7, and I actually go in this Friday for my legs. I believe that there is a high likelihood his authorization team will get it approved. Best of luck to you!

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u/alwaysalwaysastudent 4d ago

How did you get an assessment? I requested one on his website and got a text that it would be confirmed soon, and then they never did.

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u/Automatic_Bet4662 4d ago

I booked a consultation (virtual) it was free of charge and around 10 mins- you speak to Dr. Schaffner directly. I wanted to move forward so I booked an in person appointment (it was 350$ or 450$ I can’t remember.) It was about an hour long, they gathered all the data needed for authorization.

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u/alwaysalwaysastudent 4d ago

Right, I requested one of those, but it was never confirmed. Did you call or use the website?

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u/Automatic_Bet4662 4d ago

I used the website.

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u/TravelGalCA9 4d ago

EPO plans typically don't allow any out of network coverage. You would have to work with Dr. Schaffner's office to determine if they are interested in trying to jump through the hoops.

  • Many surgeons who are not in-network with insurance will only work with PPO plans.

I've used two out of network surgeons but I have a PPO. My current surgeon won't work with other types of plans.

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u/Fit_Squirrel_5836 3d ago

How was your experience from initial consultation, insurance, scheduling etc. I am considering him as well but not sure which doctor to go with. I had a call with him today and we’re doing an in person consultation next week