Do I need to call my insurance before surgery?
Asked by: Rachael Koss DDS | Last update: November 20, 2025Score: 4.3/5 (31 votes)
How soon after getting insurance can you get surgery?
Depending on your provider, insurance companies can take anywhere between 1-30 days to approve the request. Stay in communication with your care team, as timing for approval varies between insurance providers.
How do I get my insurance to approve surgery?
- Your insurance company will review your doctor's request. ...
- Once they've decided, they'll send their decision to both you and your medical provider in writing.
- If your doctor feels that you can't wait that long, they can submit an urgent or expediated request.
Will hospitals do surgery without insurance?
Each year, thousands of surgeries are performed on patients who don't have health insurance. Sometimes patients will pay for the costs out-of-pocket, and other times they will use a sharing program.
How do I know if my surgery will be covered by insurance?
Call your insurance company and ask if they will cover that procedure for that diagnosis Ask if the surgeon, the facility, and (if you know it) the anesthesiologist are all in-plan. Ask if prior authorization is required, and if a referral is needed, or is already in place.
Tips for a Patient That Can’t Get Price Quote before Surgery
Do you have to call insurance before surgery?
If your healthcare provider recommends elective surgery, your insurance company may ask for "precertification" from your provider before you can have the surgery. Check with your insurance company on what you should do. You may need to pay a copayment for the hospital stay.
How long does it take insurance to process a surgery claim?
Why do insurance claims take so long to process? Insurance claims can take up to 30 days to process. The insurance carrier needs to review each claim and ensure that the treatment is valid and covered under the patient's plan.
Do I have to pay for surgery upfront?
In other situations, including a pre-scheduled surgery, the hospital or other providers can ask for at least some payment upfront. But in most cases, a health plan's network contract with the hospital or other medical provider will allow them to request upfront payment of deductibles, but not to require it.
What happens if I go to the ER without insurance?
Despite the financial hurdles, uninsured emergency patients are provided with legal safeguards. The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.
What happens if you get surgery but can't afford it?
Government or Charitable Assistance
Financial assistance programs, sometimes called "charity care," provide free or discounted health care to people who need help paying their medical bills. The Affordable Care Act requires hospitals with 501(c)(3) nonprofit status to have programs to provide this care.
Why would insurance deny surgery?
Reasons your insurance may not approve a request or deny payment: Services are deemed not medically necessary. Services are no longer appropriate in a specific health care setting or level of care. You are not eligible for the benefit requested under your health plan.
Why does insurance take so long to approve surgery?
They just need to confirm that you have coverage and that their facility is in network. (Some procedures do require pre-certification.) But when you are trying to get that same treatment for a work-related injury, the process is quite different and that is why it doesn't happen as quickly as we expect it to.
Are all surgeries covered by insurance?
Only surgeries that are deemed “medically necessary” may be covered by insurance; surgeries that are not considered medically necessary are not covered. Note that each insurance provider has its own set of criteria for what is considered medically necessary.
How long does insurance authorization take for surgery?
Typically, within 5-10 business days of receiving the prior authorization request, your insurance company will either: Approve your request. Deny your request. Ask for more information.
Can you get surgery and pay later?
There are many lenders available that provide financing for elective medical procedures. You can sign up for monthly payments and schedule your surgery or procedure in advance.
Can I buy health insurance and use it immediately?
Many, but not all, short term health insurance plans can take effect the day after your application is received.
Can you get surgery without insurance?
Utilizing Government and State-Sponsored Healthcare Programs
Navigating the landscape of government and state-sponsored healthcare programs can provide a lifeline for individuals without insurance in need of surgical procedures.
Can a hospital kick you out for no insurance?
If you have a serious medical problem, hospitals must treat you regardless of whether you have insurance.
What do you say to get seen faster in an emergency room?
Be specific: Describe your symptoms in detail. Instead of saying “I feel sick,” explain the specific symptoms you are experiencing, such as nausea, dizziness, or chest pain. This will help the medical staff understand the urgency of your situation. Use descriptive language: Paint a vivid picture of your symptoms.
Is it normal to pay a deposit before a surgery?
Deposits are typically due to your surgeon's office to secure your surgery date. Deposits are usually a portion of your total quote and count toward your final balance. For lower-cost surgeries, the deposit may be a flat amount rather than a percentage of your quote.
Do you have to pay your copay at the ER?
But the ER copay is really a fee.
The good news, though, is that if you are admitted to the hospital, this “copay” (fee) is waived. To cut to the chase, there is not a more expensive place to receive medical care than in an American hospital emergency room.
Can urgent care turn you away if you owe them money?
The law requires hospitals to provide care for all patients regardless of their ability to pay. The same applies to urgent care facilities owned by hospitals.
Why would insurance deny a surgery claim?
Often, claims are denied based on “medical necessity.” The insurance company reviews a procedure and decides that it was not medically necessary, even though your doctor or surgeon recommended the treatment. If this happens to you, you can ask your health care provider to write a written response.
How do I send a hospital bill to insurance?
Fax or mail it following the directions on the form. The form asks to include an "itemized statement." This is either the bill that you received or the statement the doctor's office or the hospital provided to you if you paid the bill yourself.
What is the birthday rule?
The rule requires that the parent whose birthday comes first in the calendar year would cover the cost of delivering the new baby regardless of whether one parent has better health coverage for a newborn than the other.