Do company HMOs cover surgeries?

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.