Successfully planning for surgery or treatments (chemotherapy) requires more than just choosing a date.  To maximize your  benefits and insurance reimbursements, you will need to determine if your providers (doctors, hospitals, anesthesiologists) are in or out of network, and you will need to get insurance approval.  It is important to prepare to advocate for yourself or have someone advocate on your behalf.  Ultimately it is the insured’s responsibility to comply with these requirements.

The doctor’s office will initiate a Pre- Authorization with the insurance company to document the specifics and necessity of the procedure along with the anticipated length of the hospital stay.  The insurance company will respond to the doctor and hospital confirming  their allowances for fees and duration.  Sometimes the insurance company will require additional information or a second opinion to fully consider the claim.  It is important for you to call the insurance company and make sure they have approved the surgery/treatment and make sure you get confirmation of the dates.

Don’t forget to have  your Healthcare Proxy and signed Release of Protected Healthcare Information on file with your insurance company and providers, so that your family  or trusted advisors can advocate for your needs.

Post op care recommendations may also require insurance company authorization, especially if they involve transition to a skilled nursing facility or require home health care.  Check  with your insurance company prior to surgery and before discharge to make sure you understand your benefits and all necessary approvals have been received.  Do not pay any medical, surgical or hospital charges until your insurance company has processed the claims.  Understanding your insurance requirements and benefits in advance can alleviate stress and costly misunderstandings.

Healthcare Pathfinder is here to advise and support you as you plan for important healthcare events and for ongoing management of your health and long term insurance needs.