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Life Events Guide

Major Surgery

If you are facing major surgery, you should become fully informed of the Health Plan benefits covering hospitals and surgery. Also, if you have not already done so, you should make sure that you have made arrangements for financial matters such as power of attorney for health care, general power of attorney, will, and designations of beneficiaries.

Plan Checklist

  • Depending on which health plan you participate in, there are some items you should address before surgery. If you are in Kaiser or the Anthem HMO, there are procedures in place regarding 2nd opinions, pre-authorization for admission, and case management. Within these HMOs, there are procedures in place to manage the process of testing, admission, surgery, and aftercare.
  • In the PPO Plan, you are strongly encouraged to access the Preferred Provider Organization (PPO) network of physicians and hospitals for your surgery. Using a provider from the PPO network saves both you and the Plan money. To find a PPO provider, access www.anthem.com.
  • In general, it will always be preferable for you to use a PPO provider whenever possible, because you receive a higher level of reimbursement when you use a PPO provider and the providers have agreed to contractual limits on their charges.
  • Pre-Admission Testing (PPO Plan): If either you or your eligible Dependent is going to be admitted as an in-patient for non-emergency care, you should have as many of the tests required for admission performed on an outpatient basis before the hospital stay begins. Charges for these tests will be paid at 100% of the Contract Rate (PPO Network provider), or 100% of Reasonable and Customary charges (PPO Non-Network provider) after the deductible. Diagnostic testing is not included in this benefit.
  • Outpatient Surgery Facility (PPO Plan): Ambulatory surgery is surgery that is done without staying overnight in the hospital. Ambulatory surgery may be done in the outpatient department of a hospital or in a special facility known as an “Ambulatory Surgery Center”. Ambulatory Surgery Centers in the Anthem Blue Cross network can be found at www.anthem.com or by calling the Fund Office.
  • Audit of Hospital Charges (PPO Plan):  When you are hospitalized, you are urged to review the itemized bill provided by the hospital. If the hospital has charged for something that was not provided, you should contact the Plan Office immediately. If the error is verified by the Plan’s hospital auditor, you will receive 50% of the amount saved by the Plan up to a maximum of $1,000.

Also Consider…

There is risk involved any time you perform an action. There is a certain risk involved in going out your front door and driving to work. There is undeniably a greater level of risk involved in having a major surgery than in normal day-to-day activities. While it is not beneficial to exaggerate the risks involved, financial planners do recommend that people preparing to undergo scheduled major surgery should at least review several documents which would come into play in the event of death. If you have a family and/or you have assets, you should already have considered these. But if you have sufficient time before surgery, this is an appropriate point to begin working on these. Here are the items which you may wish to update, revise, or consider prior to surgery:

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