Find Out If Insurance Covers Open Heart Surgery
It's a fact of life that, no matter what your medical condition, your treatment options are going to be limited by what your insurance provider will cover. It's important when diagnosed with an illness, to quickly understand what your insurance will and will not cover, as well as what kind of documentation and referrals the insurance company needs to approve of a treatment plan. Read on to learn navigate your insurance coverage and options.
Instructions
Assess Your Condition
1. Find out if your doctor strongly recommends open heart surgery for your condition. Don't settle for a mere "Yes" or "No." Find out why she is making the given recommendation, and ask point-blank if she is being swayed by what she thinks your insurance covers.
2. Understand that if open heart surgery is just one of a number of possible options that may help your condition, your insurance carrier may only agree to pay for the less expensive options.
3. Get a second opinion. This can strengthen your claim with your insurance company.
Get the Facts Regarding Insurance Coverage
4. Call your health insurance provider. Ask if you would be covered for open heart surgery. Also ask if the provider will cover the expense of a second opinion. Many insurers will not green-light surgery until a second opinion is obtained.
5. Ask your provider about secondary expenses. Your insurance may cover open heart surgery, but that doesn't necessarily mean that you will have no expenses related to the treatment. For instance, what if you require extra days in the hospital or home nursing?
6. Ask your insurance carrier what preliminary open heart surgery-related costs may not be covered. What your insurance covers may or may not extend to pre-surgery care.
7. Consider your deductible and ask your insurance carrier how this applies to surgery. Do you have a surgery deductible that is completely separate from your office visit deductible?
8. Know that your insurance carrier works for you. You can't have too much information when it comes to either health or finances, and open heart surgery involves both. Call as often as you need to to get solid answers.
9. Read the "Certificate of Coverage" that was provided to you when you began your term with your insurance provider. If you can't find it, get a new one from your insurance plan's benefits administrator. Read about what types of surgery are covered and how much is paid for by the insurance company.
