(Newswire.net — January 13, 2020) — Does short-term disability insurance cover elective surgery? Usually not. However, the terminology in your policy is a great indication as to what will, and what won’t be covered by the insurance policy. So, the first thing you have to do is make sure you understand the terminology that’s laid out by the insurer, to understand what’s covered.
Does Short-Term Disability Insurance Cover Elective Surgery? – Is a tummy tuck covered under short term disability?
If you are a physician seeking disability insurance, you may have wondered if short-term disability insurance covers elective surgery. In this article, we’ll detail a few of the surgical procedures that are covered. We will also discuss how terms revolving around your surgery and elective procedures, will impact what is and isn’t covered, and if it is covered, to what extent.
Medically Necessary
The biggest factor that determines if your surgery is covered under disability insurance is if it is medically necessary. Some surgeries that are deemed medically necessary would include:
- A C-section
- Gallbladder removal
- Open heart surgery
- Surgery to remove a tumor or other life-threatening conditions
If the surgery is necessary for your health and is medically necessary so you’ll live your life pain-free, it’s usually going to be covered. As long as the surgery is an emergency or medically necessary, your insurance premiums are going to cover the costs.
Reconstructive vs Cosmetic
Another distinction to be made is that between reconstructive surgery, versus cosmetic surgery. A surgical procedure that’s usually deemed cosmetic, might qualify as reconstructive and may be covered if it is defined as such. A policy might have language that indicates if the surgery restores function, it might qualify. An example of this would be a breast reduction/augmentation. This, as a cosmetic procedure, would not be covered. However, if you had to have surgery after breast cancer treatments or to help alleviate back pain, many policies would consider this procedure “reconstructive” and it would be covered.
Cosmetic or plastic surgeries like a tummy tuck or liposuction would not be covered for mere aesthetic purposes. Understanding terminology in your policy and what’s covered will help you better decide if you should purchase additional coverage in case you can’t work, and require different surgical procedures.
Pre-Existing Conditions: Understand Them
Insurance experts say if you have a pre-existing condition, this might also impact whether your surgery is going to be covered by the disability insurance policy that you purchase. A majority of programs and insurers are not going to cover your surgical procedure if it stems from a pre-existing condition. Therefore, understanding what the insurance company defines as “pre-existing” is the first step to help you decide if it is worth purchasing an insurance policy to cover that procedure. From there, you’ll need to further break down
- How much is covered
- How long you’re covered under the policy
- What level they cover your income while you’re out of work
This will help you better decide if you should invest in disability insurance or forego purchasing a policy for a surgical procedure, and time off work after that procedure
So, does short-term disability insurance cover elective surgery? There’s no clear-cut answer as to what types of surgeries are considered 100% medically necessary that short-term disability insurance would cover. In most cases, it’s a policy-by-policy decision, and insurance companies dictate what’s covered, based on the terminology in their policy, and the terminology used by surgeons, who are assessing if you need insurance or not.