[Liz]

i tried to get in writing from my insurance company what they would cover post-op for a procedure they were not authorizing but they wouldn't send me anything and they were very vague on what would be covered post-op, always telling me it would depend on the situation. one of the reasons i think it's very important to obtain authorization for surgery (besides the cost of surgery) is that the cost of uncovered complications can quickly become astronomical.

what i discovered from the California Dept. of Managed Healthcare was that my insurance company was required to pay for any post-op infections i received in the hospital. they gave me the example that if someone had a facelift (usually not authorized by insurance!) and that person received an infection that insurance would be required to cover those costs.

when i spoke w/my insurance company they informed me that if i needed to revise to a fusion in the future they would pay for it but if i needed to revise to another disc replacement they would not pay for it until they changed their policy to cover disc replacement. for all other post-op treatments (PT, x-ray, doc appts, injections) i was told to rely on what was in my Plan description.

hope this helps... be sure to check with your insurance company though as everyone's policy is different. During my appeals process United assigned me a nurse case manager who proved to be somewhat helpful. good luck.

also, i noticed you are in CA so depending on your policy you may be able to appeal to the CA Dept. of Managed Healthcare for an independent review by their physicians. If they grant it, your insurance company is required to pay for it. B/c my policy was self-funded through my employer unfortunately I was unable to do this.

Liz