How to Research Insurance Companies On Reputation for Specific Procedures?

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I’m self employed, shopping for private health insurance. I have endometriosis diagnosed via laparoscopy. I have had a specialist review my case and they recommended excision as the treatment plan. I have already been on birth control for it in the past and could not tolerate it, which has been documented in my medical history.

Getting excision surgery is expensive because you must have it performed by a specialist (many of whom are not within any insurance networks due to the pricing structures–excision specialists are expensive but insurance wants to pay them like normal, run of the mill OB/GYN surgeons who perform ablation) and work with insurance on a case by case basis. Currently, insurance companies list ablation the same as excision, which is not the case, and excision really should be done by a specialist which the company may not want to pay for.

I have seen stories of people having their insurance cover the surgery as it was medically necessary by their doctors, but not without going through some kind of appeals processes. I have seen horror stories of insurance companies like Kaiser denying all claims. I would like to avoid that if I can.

Since I am self-employed I have my pick of any insurer who offers individual plans in my state (OK). The problem I’m running into is that I don’t know which insurance providers will be more willing to let me have the procedure done. I have no other health conditions and have no other significant health concerns. I’m willing to pay a high premium to get this done, but I have no need for insurance if it won’t cover excision surgery.

What would you look for to find an insurer, or insurance plan, willing to cooperate on this? Any specific language I should look for or avoid in the fine print? How do you find this information? Thanks!

submitted by /u/Negative-Presence518
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I’m self employed, shopping for private health insurance. I have endometriosis diagnosed via laparoscopy. I have had a specialist review my case and they recommended excision as the treatment plan. I have already been on birth control for it in the past and could not tolerate it, which has been documented in my medical history. Getting excision surgery is expensive because you must have it performed by a specialist (many of whom are not within any insurance networks due to the pricing structures–excision specialists are expensive but insurance wants to pay them like normal, run of the mill OB/GYN surgeons who perform ablation) and work with insurance on a case by case basis. Currently, insurance companies list ablation the same as excision, which is not the case, and excision really should be done by a specialist which the company may not want to pay for. I have seen stories of people having their insurance cover the surgery as it was medically necessary by their doctors, but not without going through some kind of appeals processes. I have seen horror stories of insurance companies like Kaiser denying all claims. I would like to avoid that if I can. Since I am self-employed I have my pick of any insurer who offers individual plans in my state (OK). The problem I’m running into is that I don’t know which insurance providers will be more willing to let me have the procedure done. I have no other health conditions and have no other significant health concerns. I’m willing to pay a high premium to get this done, but I have no need for insurance if it won’t cover excision surgery. What would you look for to find an insurer, or insurance plan, willing to cooperate on this? Any specific language I should look for or avoid in the fine print? How do you find this information? Thanks!
submitted by /u/Negative-Presence518 [link] [comments]Read Morer/HealthInsurance

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