How do you ask what is covered? Can you get an estimate for a procedure?

This seems like a really dumb question, but I always feel bamboozled every time this happens. And please let me know if this isnt the place to post this question.

I was told by work, HR, and the insurance rep who came in to explain the benefits that if we ever have a question regarding what is covered or how much a procedure would cost, to call the number on the back of my insurance card. I have Highmark BCBS for reference.

But every time I call the number, the person just repeats the information on the benefits summary. For example, I needed an ultrasound done on my liver a while ago. I called my insurance to see if I could get an estimate on the cost as my benefits summary say "100% covered after deductible" and I havent met my deductible. I called the number, and they just repeated that it is 100% covered after deductible, and only if determined as necessary. I asked if they (insurance) determine it necessary, and the rep put me on hold, then came back after 15min repeating that some treatments can be deemed necessarily depending on the criteria, etc. I asked if I could get an estimate, and they said no unless I had that medical code that is used for billing. eventually, after a lot of back and forth, we ended the call and I just said screw it and had it done as my dr felt it was necessary and I wanted answers for my issues. I lucked out and I was able to afford it, but the stress of not knowing how much I will owe can make me physically sick.

Another example, I needed a fine needle biopsy done. This time, I did get a couple medical codes from the hospital performing the procedure that I can ask my insurance for an estimate. Called the same number, asked if I could get an estimate on the procedure. Got the same response that they cant unless I had the medical codes (I forget what these are called). Provided them the numbers, and they said the codes werent working or they werent getting an estimate. I was then told sorry, they are not able to provide much more information and said to ask teh hospital performing the procedure. I ask the hospital, and they tell me I need to ask insurance since it gets billed to the insurance company.

I get these responses for everything. I am getting by, have a very small savings, so if the bill is more than $500, that wipes me out. Please note, I also try using the estimator calculator on the insurance website and it always says to call my insurance or it doesnt have the procedure listed in the directory. I am always told by everyone to call the insurance before any procedure, surgery, etc, but I never get a good response, or even a "it could be between $xxx and $xxx."

How do you do it?

submitted by /u/ExcellentPreference8
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