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For the first time in my life, I have hit my deductible AND reached my out-of-pocket maximum. I now have three months of actual free healthcare, which is unheard of in the US. What should I get done? (sh.itjust.works)

submitted 2 months ago* (last edited 2 months ago) by [email protected] to c/[email protected]

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Biologically male procedures only. EDIT: If the two people who downvoted this question could explain their reasoning, I would be super interested. No judgements. This is a safe space!

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[–] [email protected] 32 points 2 months ago

I work in American healthcare. Your doctor is actually one of the worst people to ask about coverage.

Unfortunately, the only solid way to be 100% sure of coverage is to call your insurance company and make them guarantee your planned procedures in writing. Every doctors office has a department to deal with insurance—after you talk to the insurance company you will want to talk to the insurance department at the doctors office and give them the written statement from the insurance company.

After your procedures, your bill will be processed by a medical coder at the doctors office, and a clearing house coder who gets things ready for your insurance company, before it potentially gets double checked again by coders who actually work for the insurance company. Those people will not have any clue about the arrangement made prior to your procedure, and this is the series of steps where something might happen that would cause your insurance company to not pay.

If you did your due diligence and got everything in writing beforehand, then the insurance company will kick the bill back to the doctor, at which point it will be reviewed by a payment specialist who will be able to see and use the written commitment to force the insurance company to process the bill.

This whole process takes anywhere from weeks to months, so you may not know there is a problem until a while after your appointment.

Welcome to American healthcare. Good luck getting whatever you can.