Tuesday, May 29, 2007

Know Your Insurance

I have fielded several calls in the last few days from individuals who want breast reduction surgery. Yes, they want their insurance to pay for the surgery. And yes, often insurance will do so. But as we have all come to learn, patient's (I for one refuse to call their insurance company for them prior to their first visit.) must first answer certain questions.


  • What kind of insurance do you have? Medicare, BCBS, or XYZ This doctor does not accept Medicare or Medicaid.

  • Do you know if your insurance covers breast reduction surgery? Some have it written in their policy that all breast surgery, except for breast cancer surgery, is considered cosmetic. No If your insurance doesn't cover breast reduction surgery, this would mean that all the costs would be yours.

  • Do you know if you have out-of-network benefits? No or Doesn't she accept XYZ This doctor is out-of-network for all insurance companies, but will help you file. If you have no 0ut-of-network benefits, then it will be as if you have no insurance if you see this doctor. So may I refer you to someone else whom I believe is in your network.

  • If so, do you know if you need to get a primary care referral first? No or My doctor gave me Dr. Bates' name If it is an HMO or PPO, some require this first.

May I suggest that you call your insurance company and find out the answers to the above questions before we make your appointment?

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