Is ins co liable for extra costs if I pay?

[mmarsh]

Does anyone know what happens if I pay out of pocket for ADR and something goes wrong? Is the ins co mandated to pay for say a post-op infection? What risk am I putting myself in by paying?

M-

[Maria]

I'm guessing you're talking about your regular medical insurance that may have denied this surgery or just doesn't pay for it no matter where you go?

I actually hadn't thought about that altho it's surely a valid consideration.
Looking forward to seeing what replies you get, esp. from anyone who has had complications and how that was addressed re coverage with insurance.

[mmglobal]

I have not seen coverage for aftercare or complications denied after overseas ADR, but I do know patients who's insurance companies have threatened that they would not cover complications related to unapproved surgery.

It's all going to be based on your contract and how aggressive your insurance company is. (They seem to grow bolder and bolder by the day.) Seeking coverage in advance with an insurance company that will not pay may be a double edged sword.... Unless your contract precludes you from self paying for appropriate care... you should be in good shape. If you seek pre-approval and they come back with strong warnings against... you may have given them a leg to stand on if they wish to deny coverage for aftercare.

Good luck... let us know how it goes...

Mark

[dshobbies]

I know of one instance where the insurance company specifically pre-denied complication coverage for this uncovered procedure. Other than that, they might try to deny coverage like Mark stated, but then again, they are also succumbing to public pressure so who knows.

If you inform them in advance that you're going ahead with an uncovered procedure, you also give them the opportunity to pre-deny coverage so keep your intentions to yourself.

[mmarsh]

Spoke to my ins broker and she said the company is NOT liable for complications of an "unauthorized" procedure. I couldn't find this in my policy book so I'm glad I asked. It's a big risk if something bad happens...

Missy

[ans]

Hmm. So if you pay for an ADR state-side, your insurance can deny post-surgery care e.g. doc's visits, PT, etc.