We'll Tell You if We Cover That Later

by Aimee Amodio | More from this Blogger

24 Aug 2009 07:45 PM

A member of my family has been having a terrible time with his sinuses... to the point where his doctor has suggested surgery. As it happens, I had a similar surgery when I was nineteen to cut away infected sinus tissue and correct a deviated septum. (What a thing to have run in the family!)

After he inquired to his insurance company about the surgery, he got this reply (I'm paraphrasing):

Go ahead and get the surgery, and then we'll tell you if we'll cover it.

That's a pretty big risk to take, Insurance Company, in the hopes that you'll step up and cover it. My family member has wisely opted to wait until he gets a more definite answer from the insurance folks about whether or not they will cover his sinus surgery. Unfortunately, it means he continues to suffer an ongoing sinus infection while his insurance company makes a decision.

I'm still kind of in shock that a health insurer would say something like that, and actually expect somebody to fall for it. "Whoops," they could say, post-surgery. "We don't actually cover that procedure. Or that doctor. Good luck with those bills!"

Just thinking about health insurance makes my head spin a little. I'm very fortunate that when I needed my sinus surgery, the insurance company was willing to pay for it -- without the games. (I was still under my parents' health insurance at the time, as I was enrolled full-time as student.)

I wonder what the insurance company's response would have been on something more urgent than sinus issues? Maybe that particular procedure is seen more as elective surgery than necessary surgery, and some other procedure would have gotten a more definitive answer. I'm not an insurance provider, so I don't know for sure. Cosmetic surgeries often aren't covered, but I'm not sure a surgery that helps you breathe and drain mucus from your sinuses can be considered cosmetic.

Still, I hope it's something I don't ever have to hear from my insurance company: "go ahead and get the surgery, and after you rack up a huge bill, we'll tell you if we're going to cover it. Good luck!"

I might have better odds if I went to Las Vegas or Atlantic City.

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Aimee is a fiction writer... dog lover... music lover...

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