Understanding Elective Surgery

Posted in Health Insurance

February 16th, 2009

Elective surgery describes medical procedures performed at the choice of the patient that does not provide relief in an emergency situation. Those who suffer a heart attack and then need to get emergency bypass surgery to save their lives are not electing that procedure. Conversely, those who are obese and opt to have gastric-bypass surgery to curb their appetite, lose weight and prevent the possibility of future health problems are choosing an elective surgery as the procedure can be scheduled in advanced.

There are many categories for elective surgeries. Some may be purely for self-esteem issues, some improve your quality of life and others save your life. Some examples are:

• Plastic surgery such as breast augmentation or rhinoplasty. In some cases the changes are purely cosmetic, while in others it will improve a health situation (i.e. breast reconstruction after a mastectomy, or a nose job to correct a deviated septum and alleviate breathing disorders.
• Refractive surgery such as laser surgery for improving your eyesight
• Gynecological surgery (e.g., hysterectomy, tubal ligation).
• Diagnostic surgery like a biopsy
• Cardiovascular surgery such as angioplasty to improve blood flow or heart function
• Musculoskeletal system surgery such as hip replacement and ACL reconstruction

When a physician recommends that their patient get elective surgery, the doctor will help prove its validity to an insurance company in order that the costs will be covered. Many times, second opinions are needed to help further validate the case being made to the insurance provider.

If you are currently deliberating getting elective surgery, you must review your current health insurance policy before scheduling the operation date. Insurance companies may require some preoperative procedures for you to follow before they approve the reimbursement of your surgery. The insurance company may require additional physical exams, blood work, lab tests and other diagnostic tests before agreeing to the procedure.