It’s time for open enrollment time for most insurance providers! We get a lot of questions this time of the year about insurance choices and what might be the most advantageous to our current and future patients in the coming year.
Don’t let the opportunity pass you by if you are considering Microsurgical Breast Reconstruction in 2023. You might be able to access a plan with a more reasonable deductible, a lower out-of-pocket limit, one that allows you access to a wider network of physicians outside of your local area, or that includes benefits for medically related travel expenses.
Read the fine print
A summary plan description (SPD) should be available for you to review that will outline all the benefits included in a particular plan. Call and ask questions if you can’t find the answers that help you make an informed decision. The U.S. Department of Labor(opens in a new tab) offers great resources for you to truly understand your plan information.
Look for abbreviations that restrict your access to providers such as HMO, EPO, and PPO. Confused? You can learn more from our “Bring on the Blues” blog post.
Use the provider search function (opens in a new tab) to find out if the Doctor AND Hospitals are listed as belonging to the network. These directories are only as good as the people maintaining them so calling to ask about a provider network status can be beneficial as well.
Stay in-network
Our best advice? Stay in-network to keep your financial obligation to a minimum. You will get the maximum benefit from utilizing physicians and facilities who participate within your plan network. If you can’t, see if there is an option to request an exception if no one in the plan network can provide the services you are requesting.
Keep in mind that just because you would like to use an out-of-network surgeon/facility, if there is one within your network that can provide the services, you may be denied access.
Our surgical team is in network with most major insurers in the United States including Blue Cross Blue Shield, Humana, Aetna, Cigna, and United Healthcare. There are some plans within those networks that are not included in our contracts, however, those are few and far between. We are also network providers within the multi-plan network which covers many smaller insurances plan members with access to a broad range of nationwide providers.
Our experienced insurance staff members can help you navigate your coverage and benefits and answer any questions you may have. Feel free to call or chat with us through our website chat. Remember, surprise billing is not acceptable nor lawful(opens in a new tab) and we want to make sure you are utilizing your plan benefits to their fullest!
