Does Florida Blue cover surgery?
Asked by: Madisen Hegmann | Last update: December 9, 2025Score: 4.6/5 (72 votes)
How do I know if my insurance covers surgery?
Get the CPT codes if possible from your surgeons office. Contact your insurance company via phone and provide them with the CPT codes and the name of your surgeon. They should be able to provide you with a coverage estimate based off that info. (I am a surgical scheduler.)
Does Florida Blue cover anesthesia?
Reimbursement for general anesthesia or intravenous analgesia administered by the operating surgeon, assistant surgeon, or obstetrician is included in the basic allowance for the surgical procedure performed.
Does Florida Blue cover knee replacement surgery?
Florida Blue and Mayo Clinic jointly announce a new collaboration aimed at providing the utmost in quality care for knee replacement patients in Florida. The two Florida health care leaders are teaming up to create a bundled payment agreement specific to the treatment of knee replacement surgery.
What kind of coverage is Florida Blue?
Florida Blue's Health maintenance organization plans, or HMO plans, offer a wide range of health care services through a specific, local network of our participating health care providers, hospitals and facilities, typically for a lower deductible than a PPO plan.
Understanding Your PPO & HMO Benefits
Does health insurance pay for surgery?
Health Insurance: If you have health insurance, your policy may cover all or some of the costs of your surgery. Check with your insurance provider to determine your coverage and any out-of-pocket expenses you may be responsible for.
Is Florida Blue a good insurance?
Members give high marks: Member experience ratings on metrics like customer service and getting needed care are above the average for major providers. Mix of plans: Florida Blue offers both HMO and PPO plans, giving members more options for care.
Why would insurance deny knee surgery?
A knee pain treatment insurance denial can occur for many different reasons. The claim may have been incorrectly coded or may not have sufficient information about the treatment. You may have used an out-of-network provider, or the prescribed treatment may be specifically excluded from your healthcare plan.
How much does knee surgery cost in Florida?
On MDsave, the cost of a Knee Replacement Surgery (inpatient) in Florida, ranges from $21,521 to $25,183.
Does Florida Blue accept pre-existing conditions?
Preexisting conditions will no longer apply for qualified health plans issued under the ACA. You can buy one of the health plans, even if you are sick or have had health problems in the past. Everyone who applies for health insurance can get coverage.
Does Florida Blue cover root canals?
Basic services: Treatment for gum disease, tooth extractions, fillings, and root canals are considered basic services.
What surgeries are not covered by insurance?
Cosmetic procedures such as plastic surgery or vein removal are nearly always considered elective and so are not covered. Fertility treatments are only covered in certain states, and even then, there are loopholes that allow insurers to deny coverage.
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.
Why is my insurance not covering my 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.
How much does ACL and meniscus surgery cost with insurance?
If you have health insurance, it will cost you $800 to $3,000. This cost includes hospital admission fees, post-surgical visits to the doctor, and other expenses that may come along. However, the rest is covered by the insurance company. People without medical coverage have to part with a lot of money.
How much does surgery cost without insurance?
The average hospital stay is 4.6 days, at an average cost of $13,262. If surgery is involved, hospital costs soar through the roof. Some of the most common surgeries have price tags that top $100,000. Those are alarming figures, especially for families with limited budgets or no insurance.
Is knee surgery considered major?
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven't helped reduce pain or improve mobility.
How can I get free knee surgery?
Founded in 2011, Operation Walk USA is an independent medical charitable organization that addresses the needs of uninsured patients in the United States who require a hip or knee replacement surgery.
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
How long does it take for insurance to approve knee 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.
Is Florida Blue HMO or PPO better?
Why would a person choose PPO over an HMO? While PPO plans can be more expensive than HMO plans, they offer out-of-network coverage that HMO plans do not offer. This gives you a choice of more doctors and specialists.
Does Florida Blue have a deductible?
What is the overall deductible? In-Network: $1,650 Per Person/$3,300 Family. Out-of-Network: $2,500 Per Person/$5,000 Family. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay.