How to Prepare for a Planned Surgery with Health Insurance?

Planning for surgery is more than just medical planning. Health insurance plans have a wide selection of medical procedures and surgeries that they cover, but the extent of coverage depends on the type of surgery, the terms of the policy, waiting periods, and the hospital network. Understanding what to expect and how to plan ahead can make the entire process go more smoothly and be more manageable. Read on to know more.

What Surgeries are Typically Covered in Health Insurance?

The exact coverage depends on the policy conditions and the guidelines of the insurer. Here are some of the surgeries that may be included in health insurance plans:

1. Emergency Surgeries

Emergency surgeries, like appendectomy surgeries, heart surgeries, and surgeries performed after an accident or serious injury, would typically be covered by health insurance. These procedures are deemed essential medical services and are regarded as critical health services by most insurance companies.

2. Elective Surgeries

Elective surgeries are planned ahead, but many of them are essential and also assist in enhancing the patient's quality of life. Certain surgeries, like gallbladder removal, hernia repair, cataract surgery, and others, may be covered by health insurance. These surgeries are scheduled in advance, so policyholders have ample time to finish the pre-authorisation requirements.

3. Orthopedic Surgeries

Typical health insurance plans include coverage for orthopedic surgeries like joint replacement, fracture repair, and ligament reconstruction surgeries. These treatments are typically laboured if they are medically necessary for restoring mobility, relieving pain, or preventing additional health issues.

4. Cancer Surgeries

A lot of health insurance policies cover surgical treatment for cancer therapy, such as the removal of the tumor, biopsy, and cancer-related operations. In the case of cancer, early diagnosis and timely treatment are paramount so these surgeries may be deemed medically necessary by insurance companies and be part of the terms of the policy.

5. Bariatric Surgeries

Some health insurance companies will pay for bariatric surgery, such as a gastric bypass or sleeve gastrectomy, for people who are at a very high risk of developing medical issues due to their obesity. Typically, coverage is granted if the surgery is deemed medically necessary and recommended by a healthcare provider to address significant health-related issues caused by obesity.

How to Check if your Surgery is Covered by Health Insurance?

Before undergoing a planned surgery, it is important to confirm whether your health insurance policy covers the procedure and related medical expenses.

1. Review Policy Document

Review the covered treatments, hospitalisation benefit, exclusions, waiting periods, and surgery costs sections. Most insurance companies will have a comprehensive list of the services and treatments that are covered by the insurance policy.

2. Get in Touch with your Insurance Company

Contact your insurance carrier directly to verify coverage of your surgery. You can reach customer support to learn if the procedure you have planned is covered in your policy. This can also be useful to understand the co-payment, deductible, and claim process.

3. Get Pre-authorisation

During this process, your doctor provides your medical records detailing the medical need for the surgery, and the insurance company reads and allows the treatment prior to hospitalization. Having pre-authorisation can help ensure a smoother claims process and minimise the risk of dispute issues arising afterwards.

4. Check Network Hospitals

You need to check to see if the surgeon and hospital you selected for the surgery are in your insurer's network of hospitals. Out-of-network surgeries can include claims for reimbursement and increased out-of-pocket expenses.