Any prominent health insurance company is selective of what they pay for, and unfortunately for consumers it isn't always made clear what insurance companies provide coverage for. Usually this information can be found in the handbook given to customers when they receive their policy, but even that can be vague, especially when it comes to elective surgery.

The phrase elective surgery is very much a misnomer; elective surgery often isn't elective. Biopsies, exploratory surgeries and even heart procedures may all be categorized as elective when they are generally quite necessary. This can make getting proper coverage for these operations frustrating. But it should be noted that most insurance companies will pay for what is medically necessary, especially if the insured person's life is at stake. The confusion often comes when a surgery isn't life saving per se but to improve quality of life, such as a hip replacement.

A basic insurance plan provides coverage for what is needed to sustain a healthy life, and this is where insurance companies often disagree with their clients. For example, a woman who experiences back pain may want breast reduction surgery claiming it is necessary, while the insurance company may disagree on the necessity of the procedure. Insurance companies can fight claims they don't see as being covered if it's not spelled out in the client's policy.

The easiest way to find out if something is covered in your policy is to call your insurance company. They should be able to give you a definitive answer. Anything less than definitive could be cause for alarm. Insurance companies can contest payment on any procedure, even if the matter was discussed beforehand. Of course, you can appeal any decision your insurer makes, and it's always worth a shot to fight an insurance company on a merited case.

A doctor's opinion that an operation you want is necessary will definitely help your case. In fact, an insurance company will probably send anyone seeking surgeries they have doubts about to a doctor of their choice in order to confirm its validity. This can be a good or a bad thing. If their doctor agrees with you, then most times the insurance company will stop fighting your claim. If he sides with the insurance company, then you may find your case meritless.

Getting coverage for an elective surgery may be a hassle. Perhaps the best way to find out if it is covered is to ask yourself if the surgery truly is necessary. If you can honestly say yes, then you should have a case. More often than not, handling insurance claims is all a matter of simple logic.