GORGEOUS GETAWAYS’ CarePlus Reimbursement Policy for Revision Surgery
GORGEOUS GETAWAYS is committed to providing our Members with high-quality services. Our CarePlus Surgical Reimbursement Policy is a demonstration of our commitment to you in the unlikely event that you should need Revision Surgery. For our purposes, Revision Surgery is medical treatment including surgery that is needed to replace or compensate for a failed implant or to correct undesirable consequences of a previous surgery that was booked and completed through a GORGEOUS GETAWAYS approved partner. Here is how the process works for the policy to apply.
First, the initial booking for treatment must have been made through the GORGEOUS GETAWAYS marketplace within the twelve months prior to the initial surgery and all services must have been paid for, in full.
Second, the patient must notify the GORGEOUS GETAWAYS post-care support manager of the potential need for Revision Surgery to initiate a view by the treating Medical Provider to verify the need for Revision Surgery and other details. The Patient should be prepared to provide photographs, medical reports, statements, and other information to document the need for Revision Surgery.
Third, in the event that Revision Surgery is necessary, a partial or full contribution towards surgery may be offered by the Medical Provider. The value of the Revision Surgery to be provided and any Patient contribution will be coordinated by GORGEOUS GETAWAYS with the Medical Provider on behalf of the Patient and determined as follows.
The information provided by the Patient as a request for Revision Surgery will be submitted to the Medical Provider on a case by case basis. Hospitals and other healthcare providers have a process in place for such reviews for our purposes called the Surgical Review Process. GORGEOUS GETAWAYS and by extension the patients it refers to these Medical Providers agree to accept and follow the Medical Providers’ Surgical Review Processes.
If the Medical Provider’s Surgical Review Process recommends against Revision Surgery, the Patient has thirty days from the date of receiving the opinion to object to the findings and state the reasons for such an objection. Under its CarePlus Policy, GORGEOUS GETAWAYS will discuss the objections with the Medical Provider in an attempt to resolve the difference of opinion and offer recommendations to the Patient.
Please note: The following risks are considered inherent in cosmetic surgery and are not covered by this Reimbursement Policy: Capsular contracture, skin rippling and double bubble effect (in the case of breast implants), numbness and changes in sensation, Keloid scarring, and asymmetry.
If Revision Surgery is deemed necessary by the Medical Provider, the Patient’s flights, accommodation, and in-country transportation will be covered under the GORGEOUS GETAWAYS’ CarePlus Policy. GORGEOUS GETAWAYS will coordinate the details of the travel with the Medical Provider and Patient. Flights will be booked on carriers selected by GORGEOUS GETAWAYS based on economy class fares and availability with dates to be coordinated with the Patient as well as the Medical Provider. Accommodation, up to twelve nights, will be booked and paid for by GORGEOUS GETAWAYS at a hotel comparable to the hotel initially booked by the Patient and will include breakfast daily. The Patient may, at his or her own expense, pay for upgrades to flights, accommodation, or other services.
Expenses incurred by a family member or guest traveling with the Patient are specifically excluded from this Policy.
Further conditions of this Policy:
If the Patient has insurance coverage that will pay for any or all of the Revision Surgery, then the Patient must utilize that coverage first before resorting to the terms of this CarePlus Policy. Unless otherwise required by the Patient’s insurance company, GORGEOUS GETAWAYS will coordinate the timing of the performance of the Revision Surgery with the Medical Provider and Patient to secure travel and service dates.
Gaps in coverage between the Patient’s insurance and the GORGEOUS GETAWAYS’ CarePlus Policy must be disclosed to GORGEOUS GETAWAYS as part of this process. At GORGEOUS GETAWAYS’ discretion, it may, in its sole discretion, agree to cover expenses not included in the Patient’s insurance coverage.
For this CarePlus Policy to be in full force and effect, the Patient must have:
- Except in case of a medical emergency related to the initial surgery, waited at least six but no more than twelve months from the date of the initial surgery to request review of the results of that surgery;
- Complied with his or her surgeon’s pre- and post-surgery instructions and recommendation provided in conjunction with the initial surgery;
- Refrained from smoking four weeks before and the four weeks after the initial surgery;
- Maintained approximately the same body weight as at the time of the initial surgery regardless of whether due to weight gain or loss or pregnancy;
- Refrained from drinking alcohol one week prior to the initial surgery and for the complete post-operative period until Patient has ceased his or her course of antibiotics or as advised by his or her surgeon;
- Prior to the initial surgery, disclosed to the Medical Provider any and all risk factors including but not limited to:
- Smoking, drug or alcohol dependence;
- Diabetes or thyroid disease;
- Blood pressure disorders including hypertension, limb ischemia, varicose vein or hemorrhoids;
- Heart conditions, including valvular disease or ischemia;
- Renal conditions, including chronic renal failure or stone;
- Urinary conditions, including benign prostatic hypertrophy, stricture of the urethra;
- Liver conditions, including cirrhosis or hepatitis;
- Lung conditions, including COPD, asthma or TB;
- Gastrointestinal conditions, including peptic ulcer;
- Marrow conditions, including dysplastic marrow;
- Nerve conditions, including sensory, motor or autonomic disturbance;
- Muscle conditions, including weakness, myasthenia-Gravis or Guillain-Barre syndrome;
- Uterine conditions, including dysmenorrhea and endometriosis;
- Joint conditions, including arthritis;
- Eye conditions, including glaucoma;
- Psychiatric conditions, depression, schizophrenia or anxiety;
- Systemic conditions, including autoimmune disease allergy or cancer;
- Degenerative conditions to the spine, bone, joints, eye or brain;
- Keloid scarring problems;
- Vascular or heart problems;
- Medications which could interfere with recovery;
- Allergies to medications or other non-disclosed allergies;
- HIV positive, hepatitis or syphilis.
Refrained from participating in activities following the initial surgery that may adversely affect recovery including activities against the surgeon’s advice, risky behavior, or other actions that are not in the best interests of a prompt and complete recovery.
Engaging in one or more of these activities may void the terms of this CarePlus Policy.
Should the Patient be unhappy with the aesthetic outcome of the initial surgery but the outcome is deemed not to warrant Revision Surgery by the Medical Provider or its Surgical Review Process, in consultation with GORGEOUS GETAWAYS, then the Patient will be required to contribute 100% towards any additional surgery and travel costs which GORGEOUS GETAWAYS will coordinate on behalf of the Patient. On a case-by-case basis, GORGEOUS GETAWAYS may, in its sole discretion, offer compensation, upgrades or other consideration as a gesture of goodwill to the Patient who is unhappy with the aesthetic outcome of procedures.
If any emergency situation arises, including one that the Patient considers to be related to the initial surgery, such as acute pain, acute swelling or infection, the Patient should seek immediate medical assistance from a licensed medical practitioner. The Patient should obtain medical reports and/or statements detailing the diagnosis, treatments provided, and cost of treatment, and forward this information to GORGEOUS GETAWAYS. If related to the initial surgery, GORGEOUS GETAWAYS will review the additional medical information with the Medical Provider and engage its Surgical Review Process to determine if compensation or other action is required.
For more information about this CarePlus Policy or any issues pertaining to the quality of the clinical or customer service you receive from us, please contact our Post Care Support Manager – Melanie MacGregor at [email protected]