As anyone who has been through it can tell you – a major surgery can be a life-changing experience. No one has time to plan a surgery. The idea of being under the influence of anesthesia for any amount of time is difficult. Many times, just getting to the operating table can be a trial. Depending on how you injury happened you might have to schedule it a week or a month out. Emergency situations may require you to seek immediate attention away from a Reno doctor.
Your insurance might cover it depending on the facility and the doctor, but who has time to check? Most of all who knows where to start? How do you start planning out a surgery? At the very least it will be stressful. The worst part could be yet to come. After the stress of the experience, you could be receiving bills from doctors, hospital facilities, physician groups, and anesthesiologists. If you can plan a surgery you could save thousands.
What many people don’t know is you can plan a surgery through a process called pre-authorization. By obtaining this prior authorization you are getting the “ok” from the insurance company to have the surgery. By planning out a surgery the insurance company is more likely to cover doctors or facilities that they might not otherwise cover. If your insurance does not cover the facility or doctor at all, they can suggest an alternate. Most insurance companies have a thorough and detailed process to obtain a pre-authorization.
3 Possible Outcomes
- The best possible outcome would be to plan a surgery ahead of time. This gives you confirmation from the insurance company stating they cover the doctors, facilities and operation “in-network”. This usually begins with completing a Prior Authorization Request Form and allowing the insurance company an appropriate amount of time to respond. Insurance companies are able to expedite this if the situation is urgent.
- An alternative outcome would be that some of your doctors accept the insurance but others are not. Depending on the type of plan you have (HMO PPO or POS) you may still receive a reimbursement when visiting out-of-network doctors instead of Reno doctors. This also may require you to pay an out-of-network deductible. It will always cost more to see these doctors. A HMO plan does not offer any reimbursement for visiting out-of-network doctors except in a life-threatening emergency.
- The worst possible situation would be to discover none of the doctors accept your plan. In this circumstance, you can try to find alternate doctors, wait until Open Enrollment and change to a plan that covers those doctors, or visit those doctors and pay the cash rate.Regardless of the outcome, it’s always better to call the insurance company whenever you can prior to receiving care. They cannot change your rate or offer lower plan benefits because you’re having a surgery. It will not affect your rate in the future.