My Doctor or Insurance Company is Denying My Elective Surgery

The old motto, if at first you dont succeed, try again may apply to individuals trying to navigate the health insurance industry. Your doctor may approve an elective surgery that your health insurance provider refuses to pay for. Additionally, a doctor may not believe your claims of physical and emotional distress that could be solved by approving an elective surgery. What is a policyholder to do in that case?

The first rule is to prepare to battle. Thoroughly research the terms of your health insurance policy to know how to better navigate their system. Once you have a comprehensive knowledge of their paid coverage of elective surgeries and the reasoning behind them, then you can better make your legal case.

If it is your doctor who is denying your elective surgery, then make sure to get a second opinion. Second opinions can be accredited for saving many lives. Do not be shocked if your doctor seems upset that you sought out another opinion. It is your health and your life, and you need to do everything you can to ensure you are treated in the best possible way. If the second opinion does not provide the answer you want, feel free to keep searching, as you are your best advocate. Not all insurers pay for multiple opinions, but it may be a well qualified out of pocket expense.

Perhaps your health insurer is refusing to cover the cost of your elective surgery. Be persistent as you can appeal their decision. Additionally, the court system and the public forum may prove to be a helpful tool. Take the case of Nataline Sarkisyan, the 17-year-old California girl who was denied an elective surgery liver transplant from Cigna as they said the procedure was outside the scope of their coverage. Unfortunately she died hours just after they reversed the decision, but it was her familys diligence and protest of Cignas elective surgery denial that made the reversal possible.

If you still have no luck getting an elective surgery approved, there is another possibility. You can find medical payment plans perfect for financing the cost of elective surgery. Many doctors and medical facilities have that option for their patients who are unable to get compensation from their insurer.