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Craniofacial Surgery Medical Insurance Questions

Important Information in Regards to Insurance Coverage for Cleft and Craniofacial Operative Procedures

Having a child born with a congenital syndrome can be trying for a multitude of reasons, health care being first and foremost.  Children born with a syndrome such as a Cleft Lip and Palate, Apert, Treacher Collins, Crouzon, Pierre Robin, Pfeiffer, or most common, various forms of  Craniosynostosis,  are typically provided with Medicare/Medicaid.  However, this does NOT guarantee coverage.  Many states like Tennessee (Ten-Care), and Georgia (Georgia Medicaid),  have their own in-state plans that require in-state treatment by doctors who operate within the state and are registered with Medicaid/Medicare in that state.  Having the choice of the surgeon and care providers you want can be restricted by each states individual policies. 


It is important to check if your policy applies is accepted by both the hospital and doctor of your choosing prior to scheduling an operative procedure.


If you carry private insurance like Blue Cross Blue Shield, Aetna, Cigna, Select Health, United, and others, this is typically not recognized as the PRIMARY insurance carrier for these deformities.  Medicaid/Medicare will be billed first and then the secondary carry is billed.  This can still leave you with a balance owed to the hospital and doctors.  This is called "Balance Billing" and often is in addition to your deductibles. 

Checking with your insurance carrier(s) is a priority before engaging the doctor of your choice. 

  • Where is The Cleft and Craniofacial Center located?
    The Cleft and Craniofacial Center Utah is located at 359 East 8th Avenue, Salt Lake City Utah 84103. 385.522.2344 It is important to note that all operative procedures are done in the state of Utah, as some insurance carriers do not support out of state procedures, doctors or hospital fees.
  • What Insurance does Cleft and Craniofacial Center Utah Accept?
    Cleft and Craniofacial Center Utah accepts most insurance. Dr. Sargent is registered with Medicaid/Medicare Utah. Medicaid/Medicare from other states is accepted by Dr. Sargent on a case by case basis. Some states restrict the patient from seeking care outside the state, such as Georgia and Tennessee. Dr. Sargent is a provider BlueCross/BlueShield, Cigna, United Health Care, Aetna, Deseret, and others. If Dr. Sargent is not a registered provider for your health insurance company, this does not prohibit him from performing the procedure, this simply means he is considered and "out of network" care provider. After your initial consultation, Dr. Sargent will outline the operative procedure required. The Cleft and Craniofacial Center Utah will then inquire with your insurance company as to eligibility, deductibles, acceptance of the provider by both Intermountain Health Care hospital services and Dr. Sargent’s approval to perform the surgery. Once a pre-authorization is confirmed, the operative procedure is planned. Note that pre-authorization can take time given the various providers all have their individual protocols. This process can take a day, a week, or a month in some cases. However, this is a necessary step before moving forward. You can also be proactive and check with your provider yourself, they are happy to answer important questions regarding Dr. Sargent performing the procedure, having the procedure in Utah, and if the Hospital fees from Intermountain Health Care are covered.
  • Where will the Operation Take Place?
    If the patient is a child all surgeries must be perfromed at Intermountain Health (IHC) Primary Children's Hospital. It is important to verify that both the hospital and insurance carrier are compatible as to payment for ambulatory services. Intermountain Health Primary Children's Hospital 100 N Mario Capecchi Dr Salt Lake CityUT 84113 801.662.1000 More Information on Your childs Stay at Primary Children's Hospital Intermountain Healthcare does provide financial assistance in warranted cases for more IHC Financial Assistance If your sugery is for an older patient, in their teens, or adult, there are more options as to surgical venues. Dr. Sargent has operative priveledges across all of Intermountain Health Hospitals. Minor procedures can be done in the same building as our office in the IHC Avenues Surgical Center 324 10th Ave Salt Lake CityUT 84103 801.408.7500
  • How Long Will I Have to Wait Before Surgery Takes Place?
    Once the insurance authorization is completed we can schedule you operative procedure. Scheduling at IHC Primary Children’s is usually within 2-4 weeks. If the surgery is for a Cranial Vault Remodel, (skull remodel), a neurosurgeon is required, and this can extend the time frame, as coordination with between Dr. Sargent and the neurosurgeon can take a bit more time. We do have blocked time at IHC Primary Children's, in such scheduling is quick. If you qualify to have your surgery done at The Avenues Surgical Center, as it is minor, or you are old enough to be seen there, this can take place as soon as the same week of the authorization as we maintain blocked out time at this location.

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