Health Insurance Switching...?

I received notice that on May 1st that my insurance is switching. I have a surgery scheduled for May 8th. My current policy (which will be ending) would pay 100% of the cost. The policy on May 1st pays 90% + I would have to pay a $500 deductible.

Anybody have any insight on this and how this stuff works? Should I have to pay the 5K or should I be covered 100%.

I have had the surgery scheduled since February, received the MRI and all the authorizations from my current provider. I was told that the new carrier will accept the surgery. I am only concerned about the money. I went from paying nothing, but now the new carrier will charge me nearly $5,000.

Your coverage goes by the benefits that are in effect at the time of service.

It doesn't matter what your benefits were like when you *scheduled* your surgery. You will owe your portion of the claim according to the policy that covers you when the surgery was performed.

Also...your preauthorization that you had with the old insurance company is no longer valid. If the procedure you're having is a common one that doesn't normally require medical records to be reviewed before approval, you may be okay. The insurance company MAY (note I said "may," not "will") agree to expedite precerts and preauths during the transition period for your employer's group. However, I'd still want something in writing stating that, because its not something that they are ordinarily *required* to do.

Your old insurance and any authorizations you had with them become irrelevant for any services you receive May1st and beyond.

If you want 100% coverage, then you'll have to have the surgery before May 1st. Otherwise, be prepared to pay your portion of the bill.

One of the biggest factors here is where you reside. In the US, each state governs insurance separately and the nuances you describe would be impacted based upon your locale.

the next thing I would tell you is to call yur new carrier and explain to them what you describe above and "encourage" them to see things your way.

Finally, you can call your state insurance board. their motivation is to protect the consumer so if there is a way to get things covered your way, they will find it. (that said, if they find against you, then unfortunately that's the way your coverage as written and your kind of out of luck)

I'm sorry you need to have surgery, I hope the money is your biggest concern and your health is OK.

You will owe whatever your coverage allows at the time of service. Make sure that the surgery is authorized with the new carrier and that the providers are contracted. Do not go on the word of your doctor on this. It could come back to bite you.

If you want the 100% coverage, you have to have the surgery before the current coverage ends.

You do not have the option to continue the old policy. The employer controls this.

Depending on the contracted rate, you may not owe the entire out of pocket amount , but this is difficult to compute prior to services being rendered.

If at all possible, either (a) try to have the surgery date changed to April, or (b) try to keep the existing policy, even if you have to pay for it because your employer will not.

If you do not have the insurance that pays 100% on the day when the surgery occurs, then you will not be covered 100% and will be required to pay whatever is not paid by the insurance that you have on the day when the surgery occurs.

If you do have the insurance that pays 100% on the day when the surgery occurs, then you will be covered 100% and will not be required to pay anything.

It is very simple. The only thing that matters is what insurance, if any, you have ON THE DAY of the surgery. It does not matter when the surgery was scheduled, what insurance you had earlier, or what insurance you had later.

you have gone into a trap that happens with employers group insurance.

every year they review and find another company that is cheaper than the previous;

due to the changes, i suggest you do a couple of things;
1; call and beg to have the surgery done prior to may 1; explain the circumstances. sometimes they will try and work out to help. just like at the end of the year, physicians, dentist etc are completely booked since deductibles are paid and want insurance to pay 100% rather than 1st of year when starts over.
2; if you can get surgery rescheduled, call and verify with current to see that all charges will be covered; if you had called previously and told them about the date of 5/8; they may have said 100%, but they may have also known that they would not be covering since the policy would not be in effect;
3; if cant be reschedule and new policy, call the new and ask what your out of pocket will be. you state 500 deductible; but are there copays???most coverage is 80%, so could be out of pocket say another 500 to 1k, depending if in network or out of network.

even if you have to take a day without pay if you can schedule earlier, that will most likely be less than 500 or more out of pocket.

also verify if the surgeion etc is in network; if not, like earlier, can charge higher for you out of pocket and not part of your deductible. this company is new and you dont know if you will have any problems or not; your current has shown by prior mri and other authorizations were covered, but the new may have different rules

good luck