With today’s cost of healthcare, having insurance is a must. 

In many instances, your healthcare provider won’t cover all forms of surgery. For this reason, we suggest you find out about the best health insurance plans here. 

Health insurance options are generally structured to cover the individual’s needs. However, because of the high cost of surgery, it’s essential to check which operations are covered by the health insurance plan that you’re interested in. 

Health Insurance – How Does it Work?

In the United States, healthcare may turn out to be very expensive.

 A visit to your local doctor may result in hundreds of dollars. A three-day hospital visit, depending on the care provided, can amount to tens of thousands of dollars. This expense is not something that everybody can afford. Especially if you’re not prepared for it. This is where healthcare insurance comes into play. 

Health insurance is structured to aid you in bringing down the cost of healthcare. You, as the consumer, pay an upfront premium on a monthly basis to the insurance company. This allows you to share risk with other consumers making similar payments. It also enables you to afford proper healthcare when you need it. 

There are many healthcare plans available in the USA. These plans offer a large variety of arrangements and rules regarding healthcare. Due to healthcare reform, the following essential medical services have to be included in every healthcare plan:

  • Emergency services
  • Laboratory test 
  • Hospitalization 
  • Newborn and maternity care
  • Outpatient care 
  • Substance-abuse 
  • Mental health treatment 
  • Pediatric services 
  • Chronic diseases management 
  • Preventive services, and 
  • Rehabilitation services

 For a full list of what your health insurance covers, refer to the coverage section of your health insurance policy.

Which Surgeries Are Covered by Your Health Insurance?

Health insurance companies are typically subjective in the services and procedures they are willing to pay for. Yet, specific categories of services and procedures are generally considered as either covered or not.

Most health insurance plans typically cover all forms of emergency care. This includes surgery, hospitalization, and emergency room visits in life-threatening situations.

Most healthcare providers will also contribute to the costs of non-emergency hospitalization. This includes basic board and room costs.

Preventative coverage, such as screening for chronic-diseases and cancer, is typically also paid for by your health insurance.

 Coverage of surgical procedures for non-life-threatening conditions may or may not be covered. This depends on your healthcare provider and healthcare plan. 

Optional or elective surgeries are typically not covered. The exception is, however, made for weight-loss surgeries and semi-elective procedures. These include lap band procedures, IVF treatments, and gastric bypass surgery. Health insurance companies that allow for these procedures are less common. 

Cosmetic and reconstructive surgery is generally not covered by healthcare insurance. These procedures include: 

  • Laser hair removal 
  • Skin grafts 
  • Breast augmentations 
  • Liposuction
  • Rhinoplasty

 Tissue and organ transplants are typically considered to be elective surgery. Also, finding a donor is not easy. Only 45 percent of healthcare providers have made requirements to cover these procedures. It’s essential to check your healthcare policy to ensure that a provision for this is made. 

Less than 30 percent of healthcare insurance policies cover sterilization and infertility procedures.

How Much Does Health Insurance Pay Towards Surgery?

Health insurance often pays the majority of the expense of necessary medical surgery.

 Although cosmetic surgery is usually not covered, specific procedures may be deemed necessary so long as it accompanies health-improving surgery.

 Healthcare providers align themselves with a particular group of medical providers. It’s vital to ensure that all the medical providers taking care of your surgery are part of your insurer’s network.

 Using medical providers outside of this scope will result in you paying more than you should. In some cases, you may be held responsible for the entire amount owed to a specific provider. 

The exact percentage of your copayment varies. It’s different from one healthcare plan to the next.

The Bottom Line

It’s in your best interest to read through your healthcare policy. It’s imperative to gain knowledge about what your healthcare plan does and does not cover. Also, find out which medical providers are part of your insurer’s network. This enables you to avoid any unforeseen and unnecessary costs when it comes to surgery.