Question:
If a surgeon is listed in my insurance booklet as a provider, is coverage assured?

   — Clare S. (posted on March 22, 2003)

March 22, 2003
<P ALIGN="left">Not neccsarily. It might mean your surgeon is in network, and coverage is provided for some procedures (say, an appendectomy) and not others, like weight loss surgery. </P> <P ALIGN="left">Best bet, as always, is read your policy and check directly with the insurance company.</P>
   — Kasey

March 22, 2003
I would strongly urge you to get a copy of your insurance policy/certificate. If your insurance is through your employer, they should be able to provide one for you. Then read, read, read! (particularly the exclusions section) Insurance legalease (sp?) can put you to sleep, I know, but it will be well worth it to know what your plan does and does not cover. Had I not read my certificate, I would still be taking the carrier's word for it that it was not covered when it was CLEARLY covered in black and white in my legal document!!! As far as the provider goes, one thing to know is that these surgeons can cancel their contract with the insurance companies and still be in the booklet. Double check that as I have had that be the experience with me too. With this type of procedure, the squeeky wheel DEFINITELY gets the grease!! Good luck!!
   — Kimberly P.

March 23, 2003
Generally, if your doctor is a provider it is covered (as long as that is the most current information) However, just because he is a provider does not mean the hospital where he works is. Check both. Just call the number on your insurance card and ask if both the doctor and the hospital are covered. You can then ask them exactly what the review committee needs to approve your insurance. They may have to give you another number to call but keep asking, they do have that info. and can give it to you. Good luck.
   — Jill E.