Is it possible to undergo a surgery with the company’s HMO?
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Is it possible to undergo a surgery with the company’s HMO?
For a surgery to be covered, it most require that surgical procedures be performed for medical reasons. In other words, your surgery must be necessary to correct a functional problem, to treat an infection, remove a lesion, or reconstruct your appearance following an injury that occurred while you were insured by the current carrier, etc. Before you incur a claim, read your policy very thoroughly to see what services are intended to be covered and whether you need to use a network provider, obtain prior approval, etc. Pay close attention to the stated limitations to and exclusions of coverage. Finally, while you’re in the policy, you’ll probably want to note the amount of your annual deductible and any other applicable out of pocket costs. If you believe your surgery meets your insurance policy’s criteria for coverage, your surgeon should follow the insurance company guidelines to obtain payment approval before you undergo the surgery.
Generally speaking, Health Insurance should cover all those things you go to the hospital to sort but still it is advisable to look in to the specified policy conditions. See for the disclaimer clauses in the policy. Some insurance companies provide cashless insurance. Also, I highly doubt your company’s HMO would cover selective medical surgeries, so unless the surgery is medically deem necessary, your company’s health insurance will not cover it.