Deductible and coinsurance
The deductible is the fixed amount you pay before the policy starts covering. Coinsurance is the percentage of the cost that is yours after the deductible. Both are in your policy terms and vary widely between plans; they are used to calculate what you will pay.
Waiting periods and pre-existing conditions
Many policies have waiting periods for certain conditions and exclude those that existed before the policy was taken out. If your policy is recent, or if the problem was diagnosed before you bought it, it is worth clarifying that with the insurer from the start. The office reviews it with you.
The authorization letter
For scheduled surgery, the insurer issues an authorization letter from the medical report and the quote. The office prepares those documents and follows the process. With the letter, coverage is confirmed and surgery is scheduled at the hospital.
Emergencies
In an emergency, such as appendicitis, the paperwork starts at the hospital on admission. Tell admissions you have insurance and have the policy number at hand. What is covered depends on your terms.
If your insurer is not on the list
Some policies allow you to be treated privately and claim reimbursement afterwards. The office tells you which documents you will need. The insurer list is on insurers.
