Is "Surgery Plus" for real?

October 20, 2024 5:37 PM

My employer (USA, major co, medium size city) is now offering Surgery Plus as a benefit. It seems too good to be true. Have you ever heard of it or even better, used it? According to their website: "We cover the most expensive costs associated with surgery. Depending on your benefit plan through your employer, using Surgery Plus means your surgery will be available to you at little to no cost."

I called Surgery Plus and they claim I can get an Upper GI Endoscopy for $0.00 . What's the catch? How can they afford to do that? I'm a bit worried I wouldn't be getting great care at a place charging zero dollars. But I also like the price and might be willing to risk it!

posted by pjsky to Health & Fitness (7 answers total)

I'm sure the place isn't really getting paid zero dollars. Surgery Plus has a network of surgeons etc. that have contracted with them to do the services for whatever the agreed upon rate is. Your employer is paying SP and SP uses those premiums to pay the doctors. If you look at the "for provider" page, they advertise that they can provide doctors with patients from a wider area and with simpler paperwork and maybe fewer preauthorizations and after the fact reviews ("we trust our doctors"). The key question for you is whether the doctors that you would want to use are in their network. That will depend in part on how well they pay and whether doctors in your area are looking to expand their practice or if they are already swamped.

If you were a doctor, I would warn you that there is a history of companies entering the medical services space where their long term plan is to squeeze the professional provider so they can advertise cost savings to the employer and attractive low cost to the patient. But in your situation, that translates back into the question of who are the doctors who agreed to participate.
posted by metahawk at 6:04 PM on October 20 [3 favorites]

So just off the top of my head this sounds like a specific additional insurance that's just for surgery. Do you know you have that endoscopy coming up? If yes, do you know how much your current insurance wants you to pay for it? I have decent insurance; my upper endoscopy last year cost me something like $100 as a copay.

For me it'd just boil down to "how shitty is my current insurance for surgery" and if the answer is "very," then maybe it's worth paying the premiums for this supplement?
posted by BlahLaLa at 7:08 PM on October 20 [2 favorites]

I recently had major surgery and since I had already met my deductible for the year, my out of pocket costs are going to be less than $200. I was actually pleasantly surprised - but my employer provides pretty good coverage.
posted by brookeb at 8:43 PM on October 20

Are pre-existing conditions covered?
posted by samthemander at 8:45 PM on October 20

What's the catch?

You need to require a upper GI endoscopy. All things equal, I would prefer to avoid one.

How can they afford to do that? I'm a bit worried I wouldn't be getting great care at a place charging zero dollars.

They are being paid by your employer to provide coverage for surgeries in a way similar to health insurance on general. Think of them as a highly specialized form of health insurance.
posted by saeculorum at 5:26 AM on October 21

My coverage has similar options for cancer treatment, maternity care, transplants - all kinds of stuff. The "catch" is it only applies to certain providers, which is not a drawback necessarily unless you have a provider you are invested in and they are not part of it.

I imagine this is the same and is a way for the insurance carrier to manage costs by making a contract with these providers for their services at a certain rate. By steering you towards certain providers, they can control costs a little more.

mine is included, i don't know if yours is additional premium or not. Depending on the additional premium it could be a very good deal if you know you will be needing a surgery and i would expect a normal standard of care. If the premium is high, then maybe not.
posted by domino at 8:54 AM on October 21

It's basically supplemental medical insurance. They used to sell "MediGap" that covers the stuff that's not quite covered by MediCare, same idea, except for private insurer. If your employer wants to pay for it that's great, but I have a feeling it's actually deducted from your salary as an optional coverage.
posted by kschang at 12:14 PM on October 21