Preston Nafz, a teenager who loved playing lacrosse, had to undergo a sports hernia repair surgery due to persistent pain in his left hip. The procedure cost $7,105, but his father had to pay upfront as the surgery did not have a specific billing code for insurers. After the surgery, the father filed a claim with their insurer but only received a partial reimbursement of $620.26. The lack of a specific CPT code for the surgery caused confusion and reimbursement issues with the insurer. It is recommended to confirm insurance coverage and billing codes before undergoing a medical procedure.
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In Chronic Pain, This Teenager ‘Could Barely Do Anything.’ Insurer Wouldn’t Cover Surgery.
