Questions to Ask Your Insurance Company

Questions to Ask Your Insurance Company

Any surgery requires a lot of work and preparation in order to insure that everything goes as smoothly as possible. During the surgery, the doctor and his team handle everything. Immediately after, you’re checked on, and they make sure you can reach a bare minimum level of activity. Then the rest of the time, you’re virtually on your own to make sure you have the help and care you need. It’s important to make sure that you are well cared for on all ends from the financial portion to getting back up and moving. Here are five questions to ask of your insurance company to make sure your needs are covered.

Am I covered for this procedure?

This is perhaps the most important of these questions for deciding if the surgery is financially available for you. It not only determines whether you’re paying for it out of pocket or if your insurance will pay for any or all of it. Most won’t pay for it all, but many may pay for a high percentage of it depending on the need and risk. This helps you decide over the long term whether the surgery is financially feasible for you.

What are my co-pays and deductibles?

You will need to know just how much your deductible is and how much of it you have left to pay. While deductibles determine what you pay overall, co-pays determine what you pay the day of. Most co-pays are relatively small compared to the full cost of the surgery, but they can still be hundreds of dollars depending on the surgery.

Do I need pre-authorization?

Preauthorization is fairly standard practice unless for emergencies. This allows them a space to refuse the surgery if the risk is too great, but if they cover the surgery overall, most of the time this is a formality that is required. It can still be a hassle to handle if not taken care of beforehand.

Do I need a second opinion or a referral form?

In most cases, the referral is covered in you simply seeing the orthopedic surgeon for consultation, but you should check just in case. The second opinion can be standard fare for more complicated and therefore expensive surgeries. Your surgeon should have no problem suggesting someone else covered by your insurance that will help.

Is therapy or care afterwards covered?

This is the most important piece of the surgery cost that you should ask about. Most surgeries like orthopedic require some type of therapy afterwards. This therapy should help you get back to moving the way you want. Many of this therapy is eliminated by the hospital, but you often really need it to prevent injury and get you closer to normal faster.

This article is brought to you by Dr. Brandon Downs, of Orthopaedic Specialists, specializing in knee, hip and shoulder pain. Find Dr.Downs in Nashville, Dickson and Ashland City and online at


1912 Charlotte Ave, Nashville 37203, (615) 590-8000
415 Henslee Drive, Dickson 37055, (615) 375-8287
313 North Main Street, Ashland City 37015, (615) 590-8000

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