How can you be sure that a medical procedure will be covered by your insurance?

When it comes to a health plan, the specifics can seem complicated and overwhelming. If you are considering a service and want to ensure that it is covered, it is important to take a few steps.

First, check your certificate of coverage that you received after you were first enrolled with the carrier. A good place to start is in the exclusions section. This portion of your certificate will spell out any service that is specifically excluded from coverage. You can also contact the carrier with the number on the back of your ID card. Their representatives are often able to check your certificate for you.

Next, if you are not comfortable with a response that you have received from the carrier and would like to receive additional varification, you can ask your provider for diagnosis and procedure codes. Once you have these, our team is able to check with our dedicated representatives to see if those procedures would be covered by your plan and if you would need a pre-authorization.

It is important to note that while our team is able to verify if your procedures codes would be covered with your diagnosis codes, sometimes it is necessary for a provider to bill additional or different codes, which may not process as you had expected the verified codes to process. However, it is always a good idea to be as proactive as you are able to be and check what codes your provider is able to project before your procedure.