A person raises many questions and concerns related to the surgical procedure itself. Also, he gets worried about the cost or you can say “surprise bills.” Different States have a different law to address this concern, but there are some questions which a person should ask before his or her surgery, to avoid any surprise later.
Am I Aware Of All The Nitty-Gritty Details Of My Insurance Policy?
Before you plan your surgery make sure to have a conversation with the insurance provider to further understand each and every detail of your health policy such as, co-insurance responsibilities and deductibles.
Katalin Goencz, co-president of a not-for-profit organization named Alliance of Claim Assistance Professionals advises, Your out-of-network benefits requires more particular attention. You may be reassured about 80% coverage provided by your policy. Goencz further said, “It doesn’t mean that your provider will pay 80% of your total bill, but you’ll be eligible for the reimbursement of some maximum amount based on the in-network rate of Medicare. So the sharing cost may not be what you were thinking of.”
Do I Need To Tell My Insurance Coordinator What My Surgery Will Entail?
Goencz added, “ It is advisable to inform your billing coordinator about your ABC procedure which is scheduled with the X surgeon at Y hospital on Z day. The provider generally uses CPT (Current Procedural Terminology) codes to identify the surgical procedures. So to get the best estimate of your code you first need to first ask the insurer what code they use to identify the procedure.
Is My Primary Surgeon Is Included In My Insurance Network?
Before you plan your surgery, make sure your surgeon is included in the provider directory and also cross check with the office manager to further confirm.
Karen Pollitz of Kaiser Family Foundation, said “Even after your due-diligence with facilities and primary surgeon, you may get the surprise bill from anesthesiologists, radiologists, surgical assistants and pathologists (out-of-network providers).”
Betsy Imholz the director of special projects at the Consumer Union further added, “If your state doesn’t provide you consumer protection facility then you can ask your surgeon that to save money you only want in-network providers.”
It’s your right to ask which doctors are included in your providers list. Even after taking appropriate measures if you still get a surprise bill then you can go for appeal.