SPDs
hkh70
3 Posts
We currently have a conflict internally regarding SPDs. One business unit wants complete detail on all, and I mean all, procedures that are covered. The other business unit believes that this may be too risky as many procedures require medical evaluations and have guidelines surrounding when it will be covered. Without creating a 1,000 page document, does anyone have any ideas as to how to get around this conflict?
Comments
Every year after I complete benefits open enrollment the insurance company (in my case BC/BS) sends me SPDs for my plans that I hand out to all of my employees enrolled in the plan. I would have the insurance company send you this information and you can hand them out. If they have further questions regarding whether something is covered or not then they can call the customer service line for the insurance company. Most insurance companies require pre-authorization for a surgery/procedure anyways and this is when they find out everything that is covered. In some cases it is hard to determine what is covered and what is not covered until the doctor makes a medical case for why it is necessary and describes to the insurance company what the procedure will entail.