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.
September 24, 2019 | 2 min read
Christa S. Plew, MBA
Editor-in-Chief

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.

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