Insurance and surgery

Jasmine8

Hey ladies, I was wondering if anyone can help me with an insurance question. I had a double mastectomy a few months ago and had expanders placed and I will be going in for my reconstruction surgery in 3-5 months. This year I have a PPO plan but am considering switching to HMO for next year before I go bankrupt. I know that insurance is required to cover the reconstruction after a mastectomy but what if you change the type of plan? Any chance they will give me a hard time? I am planning on staying with the same company (blueshield) just switching from PPO to HMO. I am scared they will deny my surgery or give me a hard time.

RocDocVic

Insurance and surgery

Jasmine8

Dec 6, 2023

Hey ladies, I was wondering if anyone can help me with an insurance question. I had a double mastectomy a few months ago and had expanders placed and I will be going in for my reconstruction surgery in 3-5 months. This year I have a PPO plan but am considering switching to HMO for next year before I go bankrupt. I know that insurance is required to cover the reconstruction after a mastectomy but what if you change the type of plan? Any chance they will give me a hard time? I am planning on staying with the same company (blueshield) just switching from PPO to HMO. I am scared they will deny my surgery or give me a hard time.

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I would call them to see exactly what they cover under both plans. Also check to see if all doctors and other medical specialists on your surgery team, including reconstruction specialist and anesthesiologist, are in both plans. Same with hospital. Ask if you need preauthorizations and length of stay that is covered. Make a table with columns for each plan and lines with questions. Take notes for each plan, pros and cons. Lastly, out of pocket expense costs, deductibles etc. Know what your costs will be. Ask your teamor hospital billing department to provide estimated costs for both plans.