Seattle Plastic Surgeon offers unsolicited advice on determining if your health insurance will cover a procedure.
“Will my insurance cover this?” I hear that question a lot, especially with the Affordable Care Act becoming law. I even had a patient ask if Obama Care would pay for her breast lift! Wouldn’t that be sweet?
Here are some tips on determining if your health insurance will cover a certain procedure or treatment:
1. Read your health care manual. Often the answer will be there. If you don’t have a manual, obtain one from your employer or the insurance company. If the manual says something like “no breast surgery is covered unless it is related to breast cancer”, insurance will not cover procedures like breast reduction or breast implant removal. It’s right there in black and white.
2. Call your insurance company and talk to someone in customer (that would be you) service. You may get the run around or a phone tree from hell, but you should eventually be able to reach someone who can give you some answers. Remember that you are their customer and you should expect good service.
3. If you are getting what you feel is an unfair answer, talk with your benefits manager or even your state insurance commissioner. Insurance companies are happy to collect their premiums but can be downright prickly about money going the other way. Sometimes they need a little prodding.
4. Have your doctor’s office call. Sometimes the insurance companies have a problem with plain English and do not understand a questions such as, “My breasts are ginormous and are killing my back and I’ve maxxed out my physical therapy budget and industrial strength bras don’t help. Is breast reduction a covered procedure?” The person in preauthorization may only understand “611.1, 724.5, 781.9 and 19318-50”. Your doctor’s office can provide those numbers.
And remember – just because insurance does not cover a procedure or treatment, that does not mean you cannot have said procedure or treatment done. It’s just that you will have to pay for it.
Thanks for reading and let’s hope this Obama Care thing works out! Dr. Lisa Lynn Sowder