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Glossary
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WHAT IS COVERED

Surgical Costs

Covered expenses related to a surgery or operation include:

  • The surgeon’s immediate pre-operative examination;
  • The surgical procedure itself and an assisting physician, if the procedure requires one and the hospital does not have any available staff physicians qualified to provide the needed assistance;
  • The post-operative care needed for the procedure; and
  • Any breast reconstruction required after a mastectomy, and the purchase of any prosthesis (artificial implants) needed as a result of a mastectomy.

If you have more than one surgical procedure performed at the same time, the maximum covered charge equals the allowable charge for the most expensive procedure plus one-half the allowable charge for each additional procedure.

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