Your doctor may recommend a test or procedure, but there are a few questions you should ask before scheduling it.
First, determine whether the provider and the facility where the service will be performed participate in your Medicare Advantage plan’s network. A physician may participate while a hospital, imaging center, laboratory, or other facility does not.
You should also ask:
- Is the test or procedure covered by my plan?
- Does it require prior authorization?
- Has the provider obtained the required authorization?
- Is the facility in-network?
- Are there other providers involved whose network status should be checked?
- What should I expect to pay?
For expensive or non-emergency services, consider contacting your health plan directly to confirm coverage and network participation.
Remember that a doctor’s recommendation and an insurance company’s coverage decision are two different things. Your doctor determines what care they believe is appropriate. Your health plan determines how that care is covered under your benefits.
If you have an upcoming test or procedure and are unsure about your coverage, contact Regional Financial Security Agency before the service. We can help you understand what questions to ask and how to verify your benefits.