Insurance Related Questions to Ask

Not sure what questions to ask regarding your insurance coverage for an upcoming procedure? Here are a few questions to help begin the conversation.

Ask your doctor…

  1. What are the codes (CPT® codes) you will bill for this procedure?
  2. With which insurance companies are you considered in-network?
  3. Does your procedural cost include any pre- or post-op appointments?
  4. Who in your office handles billing and insurance?
    a. Could I meet with him/her to gain a better understanding of what to expect?

Ask your insurance provider…

  1. Is procedure code XXXXX (e.g., 27130) covered in my policy?
  2. Are there any exclusions related to that surgery?
  3. What are the criteria for determining medical necessity?
  4. Are both my surgeon and hospital considered in-network?
  5. Is there coverage for services after the procedure such as physical therapy, home health, or inpatient rehabilitation? If so, how much time and how many sessions are covered?
  6. Is prior authorization required for the procedure?

Ask your hospital…

  1. I’m having ABC surgery, what is your price for this procedure?

Zimmer Biomet is not a healthcare provider and does not provide advice or instruction on insurance coverage. All questions regarding your insurance coverage must be directed to your insurance company and healthcare provider.

CPT® is a registered trademark of the American Medical Association.

Please let us know how useful this article was to you

Thank you for rating this article.

Here's more you can do

Share Your Story

People like you need to hear that they're not alone. Your story can make a difference in their life.
I Want to Share My Story

Be Informed. Be Prepared!

Sign up for personalized article recommendations in your email.
Get Updates

About Us

Learn more about who we are and our mission of helping patients find balance in their lives.
About Us

Find a Doctor

Search by speciality, location and more. Find the right provider for you.
Find a Doctor