If you’re faced with an upcoming surgery, details like health insurance may be the last thing on your mind. Nonetheless, understanding your health insurance coverage is important. There can be a lot of information to process - so figuring out which details apply to you under what circumstances can sometimes be overwhelming.
Below are some frequently asked questions (and answers) about health insurance and your upcoming surgery at Virginia Ear Nose & Throat.
Will my surgery require a pre-authorization?
Our surgery schedulers will contact your insurance company regarding authorization for your surgical procedure. If there are any difficulties obtaining a pre-authorization the surgery scheduler will contact you directly.
Will there also be a hospital charge?
With any outpatient surgical procedure you can expect a claim to be filed on your behalf by the surgeon, the facility where the surgery was performed, and the anesthesiologist. Your insurance company will process each claim separately.
How can I estimate my out of pocket expenses?
Every patient’s policy is different. We recommend you contact your insurance company directly to review your outpatient surgical benefits. A claim will be filed to your insurance company on your behalf. Most patients have a deductible to meet before their insurance company makes payment. After the deductible is met you may also have a co-insurance. For instance, some policies may have a co-insurance benefit of 20%, meaning the insurance company pays 80% of the approved amount and the patient is responsible for 20%. Most policies have a maximum out of pocket limitation as well. Once your maximum out of pocket is met for the year your insurance company will pay 100% of the approved amount.
It is very important for you to understand the benefits provided by your unique policy. The best way to do that is to call your carrier and have them review your benefits.