Insurance Needs before a Medical Surgery: How to Prepare

The choice to have medical surgery is a major decision. Before surgery need to get strong muscles and have to start best home workout programs. The misconception that many people have is that medical surgery is all on one bill, and that as long as that is covered by your insurance providers then you are in the clear.

In reality, most medical surgeries have multiple bills for the surgeon, the operating room, anesthesia, hospital stays and many other related bills you have to expect different possible outcomes for each bill you are faced with. It is important to follow all steps to research your plan of action and understand what you are walking into in order to be best prepared to face your expenses

Understand your Health Care Laws

It is important to first understand your health care laws and rights when reviewing the possibility of surgery and speaking with your insurance care provider. If you have bought health care insurance and have been paying your monthly premiums, then you cannot be denied health insurance if you have a medical condition that arises.

There is a core set of essential benefits that must be covered by your health insurance plan such as x-rays, hospital visits and CT scans. It is important to research and understand your rights in conjunction with your health insurance plan, and make sure you stay up-to-date with any changes in your policy.

Speak with your Doctor

The first step you need to take is speaking with your medical practitioner regarding exactly what the surgery entails. How many operations are involved and does it require anesthesia? It is important to also ask what will happen if the route of surgery changes during the operation and whether additional bills will be incurred.

Make sure to make notes of all the information the doctor provides to you about confirmed surgical and medical steps, and potential extra steps that might be required depending on the outcome.

Speak with your Insurance Provider

Once you have gathered as much information as possible from your medical
practitioner, talk to your insurance provider next.

Make sure you go over every procedure the doctor has listed as a confirmed action and provide the insurance company with the possibility of extra procedures as listed by your doctor.Your insurance provider should be able to review what will be covered by their company and what will be out-of-pocket for you for you.

Make sure you list every point that the doctor has given you regarding the outlined steps of your procedure, before during and after. It is important to enquire about pre-authorization requirements as well, which is a pre-approval that is needed for expensive surgeries.

Confirm whether or not all of your providers are In-Network

An in-network provider is an insurance company that has an agreement with certain medical practitioners to offer less expensive services for insured patients.
Ask about whether or not there are any contracts available with any medical providers through your insurance company to try and keep your costs as low as
possible. If you go outside of the network you might still be covered but expect to pay a larger portion out of pocket for the procedural costs.

Keep in mind that it just because a doctor accepts your insurance provider, it does not mean that they work in-network together. Similarly, just because your doctor chooses a hospital to perform an operation on you, it does not mean that the hospital they choose is in-network with your provider as well. It is important to ask the provider for this information in order to make an educated decision on where you will consider getting your procedure done.

Determine Your Share of the Costs& Understand your Deductible

Insurance providers are offering policies with higher deductibles now, so there is
definitely some shared responsibility surrounding costs associated with your procedure. How this works generally is that the insurance provider picks up the
balance of your costs after you pay the set deductible amount as stated in your policy. There is usually also a percentage charged as a coinsurance fee.

For example, if your deductible is $1000 with a 15% coinsurance fee, you will pay the $1000 deductible fee plus 15% of the overall surgery cost, with the insurance provider paying the balance. It’s important to research which services actually require a deductible as not everything will. For example, a general visit to the doctor’s office should only cost you the coinsurance payment.

The best place to get more information on coinsurance payments is actually your doctor’s or hospital’s billing team. They can gather information based on your insurance policy to provide you with the best rough estimates of the costs you may incur with your procedure or medical surgery.


It is important to do your research where possible prior to performing a medical surgery, to insure you make the best decisions to ensure you do not have any high expenses that could have been avoided, and to make sure you understand the medical bills you will be incurring by proceeding with your operation. By speaking with the right people, taking notes, and asking the right questions, you will have a thorough understanding of what to expect prior to undergoing surgery, making your recovery stress-free.




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