Elective Surgery and My Insurance Coverage

elective surgery insurance coverage

Typically, health insurance companies will pay for elective surgery they deem as life saving. Cancerous tissue removal, angioplasty, vision correction and gastric bypass surgeries are all types of elective surgeries that doctors can (and often do) qualify as necessity for improving or maintaining your quality of life.

It is up to the policies of your insurance company to decide what elective surgeries they will cover. Many times insurance companies will opt to pay for elective surgeries that may not be deemed immediately necessary but can prevent further illness and expenses down the road. Some examples include cataract removal that will prevent the cost of eye wear in the future, sterilization which reduces the cost of birth control, gastric bypass and other weight loss procedures to prevent future complications associated with obesity such as diabetes and heart problems, and nose jobs to help correct breathing problems.

The laws that mandate health insurance coverage differ from state to state. Health insurance providers handle their elective surgery claims differently. It is vital you know your rights and responsibilities as a policyholder, as health insurance companies generally base their coverage decisions on the necessity of a procedure. It is the term “necessity” that can make or break you when it becomes time for them to pay for the operation.