Has anyone ever paid up front/then been reimbursed when/if insurance covered it?

[kacee 3]

This may sound like a stuipd question. Just wondering. My surgery is scheduled for the 23rd. My insurance was submitted April 19. There is a possibility I may not get word back from the insurance before the surgery date (even though I fully expect to be denied and fully expect to be self-pay). Has anyone ever heard of someone self-paying and then being reimbursed if the insurance DID come through after the fact?

[Alexandra 55]

Kacee, there are types of insurance policies that work by reimbursing people after the fact, but those are the old-fashioned "indemnity" plans. If you have a managed-care plan (which most are, these days), it's highly unlikely that you would be reimbursed if you have surgery without preapproval.

If you are denied and pay yourself, you can always continue your appeal process of course. But even if you manage to have the denial overturned, the coverage of surgery would be "in accordance with the terms of your contract" -- and almost all managed-care contracts require PREapproval for surgery. Ergo, they'd have yet another reason to deny coverage.

The bottom line is that if you believe you have a shot at getting your insurance to cover it at all, you want to see the whole process through BEFORE paying for it yourself.

[kacee 3]

Thanks much....you basically told me what I think I knew in my heart. I sure don't want to have to postpone, but I guess I may have to. It will boil down to how long before surgery I am required to cancel by the doctor I guess.