Insurance Coverage

Getting Help from the Pros

A fter you have faxed or mailed in your Health History Form, you will get a call from one of the insurance analysts to discuss your insurance coverage. She will tell you what your specific insurance company requires of you in order to complete your authorization process. The requirements vary tremendously, even under the same overall provider, so you may find that your pre-operative requirements differ from other patients’. Because this can be an intricate process, unique to you and your specific coverage, you will have ongoing close communication with your insurance analyst, who will serve as your “go-to” person during this period of time. It is important that you pay close attention to the details of your plan's requirements, so your claim doesn't get denied due to lack of information.

You will also be contacted by the office to set up an in-office or telephone visit with me to review your personal health history. I will tell you what tests you need to have and in what order you need to have them. I will also advise you on what medications you might have to stop taking before surgery and we'll lay out a timeline and a to-do list for you. (This list will also be mailed to you as a reminder.) After this conversation, I will compose a letter of medical necessity to send to the insurance company, if required.

Your insurance company may approve surgery in a matter of a couple of days, or it might take weeks or months, so I always encourage people to get the forms sent in as soon as possible so you can avoid scheduling difficulties in case of an insurance delay. If your insurance company is uncooperative, I am always happy to personally contact the Medical Director of your insurance company.

Cash paying patients do not incur the insurance delays, but do go through the other medical assessment and pre-operative testing.