Elective surgery refers to any nonemergency procedure performed based on the doctor’s recommendation or the patient’s choice. Elective surgery is scheduled and planned for ahead of time and may be done at either a hospital or ambulatory surgery center (ASC), usually on an outpatient basis.
While the term “elective surgery” encompasses those that are performed for aesthetic reasons (e.g., liposuction, rhinoplasty, and other types of cosmetic surgeries), it also includes those that are deemed medically necessary (e.g., joint arthroscopy, joint replacement, tonsillectomy, etc.). Elective surgeries performed for medical purposes are aimed at:
- Addressing a sports injury
- Correcting a congenital or acquired deformity (e.g., cleft palate or post-mastectomy reconstruction)
- Facilitating medical treatment for cancer or other types of serious health problems
- Improving the patient’s quality of life
With elective surgery, you and your surgeon will discuss preoperative preparations, the benefits and risks of the surgery, the details of the surgery itself, expected outcomes, and a recovery and rehabilitation plan, if necessary.
If you’re contemplating getting elective surgery, you would want to know all of the important details, including your financial obligations. One of the questions you might ask is whether your health insurance will pay for your elective surgery. Here are some bits of information to help you.
Determining the Coverage of Your Health Insurance
Health insurance coverage is essentially determined by medical necessity. Nonetheless, to be sure, talk to your health care provider and check with your health insurance to determine if your case falls within the coverage.
Some health insurances require:
- Referral from your primary care physician
- Prior authorization by the health insurance entity
- Cost-sharing by way of a deductible (the patient pays a certain portion of the medical costs)
It also helps to know what your out-of-pocket costs will be and whether it is advantageous for you to have your surgery toward the beginning or the end of a calendar year. Check the hard copy of your member benefits or your health insurance website for details specific to your plan.
Ambulatory Surgery Center in Naples, FL
At North Naples Surgery Center here in Naples, FL, we are ready to help our patients navigate the financial obligations attached to their elective surgeries. We are a Level II facility, fully accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). We adhere to the strictest standards for surgical procedures and other healthcare services, and we are committed to delivering the highest quality of patient care.
If you’re scheduled for elective surgery with us, you can count on our billing specialists to help you understand your insurance coverage and your bill. For questions, please call our Naples, FL, office at (239) 529-2811. We are located on the third floor of the Executive Medical Center.
