Will my elective surgery be covered by short-term disability?
You may be wondering if short-term disability insurance coverage will pay for your expenses while you’re out of commission after an elective surgery. Your specific surgery and disability insurance policy will determine the extent to which your coverage can assist.
What does short-term disability insurance do?
If you are out of commission for a brief time due to an injury, illness, or recuperation following a medical procedure, short-term disability insurance (STD) will reimburse a portion of your salary—typically 80% of your gross income—in the event that you are unable to work. Submitting a claim for benefits to your insurer is the first step in the event of a disability.
Your policy will specify the maximum amount of time you can get benefits, known as the benefit period, which might range from three months to one year. Typically, there is a one-to fourteen-day “elimination period” (the time it takes to get from the time of diagnosis or damage to the time of collecting compensation).
Does short-term disability cover elective surgeries?
In the event of an accident, sickness, or medically required surgery, you may be eligible to receive payments from short-term disability insurance.
The exact definition of “medically necessary” will vary according to insurance policies, but in general, a procedure qualifies if it is both recommended by your doctor as a necessary therapy for your accident or disease and is also considered appropriate by medical professionals.
Additionally, the limitations and exclusions lists will be different for each policy.
It all depends on your policy, but these might include things like pre-existing conditions, injuries caused by yourself (including attempts at suicide), injuries or illnesses caused by illegal drug or alcohol use (including damage from drunk driving accidents), and more.
Does short-term disability cover plastic surgery?
When deciding whether or not to pay benefits, short-term disability insurance companies make a distinction between cosmetic surgery and reconstructive surgery. To be eligible, the operation must restore physical function, according to several policies.
Since they are not considered medically necessary, most insurance companies do not pay for cosmetic operations. However, there are several situations in which breast reduction, augmentation, or reconstruction surgeries might be covered, such as following breast cancer treatment or to ease persistent back discomfort.
Craniofacial reconstruction following an injury is one example of a reconstructive surgery that is typically considered medically necessary and therefore covered.
Does short-term disability cover weight loss surgery?
If the gastric bypass, bariatric, or lap band surgery is deemed medically essential to alleviate a physical ailment, many insurance companies will cover the costs of the treatment as a short-term disability.
Coverage would most certainly apply to a gastric bypass procedure that treats a physical ailment, such as breathing difficulties. It would not pay for the same surgery to make one look better. Abdominoplasty, or a “tummy tuck,” is less often covered and requires proof of medical need.
Does short-term disability cover dental surgery?
Depending on your treatment plan, you could or might not have recovery time after dental surgery. Some dental insurance plans may not pay for procedures like wisdom tooth extractions.
In most cases, medical expenses will pay for any necessary surgeries following an accident or injury.
Does short-term disability cover orthopedic surgery?
You may be able to get benefits from your short-term disability coverage if you undergo a surgical procedure to relieve discomfort in your hips, feet, knees, ankles, elbows, shoulders, hands, or spine. Common orthopedic procedures include knee and hip replacements as well as rotator cuff repairs.
But remember that short-term disability won’t pay for operations to fix injuries you got on the job. Rather, workers’ compensation will pay for injuries sustained on the job.
Medical tourism and short-term disability
Due to the potential for cheaper procedures and operations in other countries, some Americans opt to travel abroad for their medical procedures.
Having said that, many short-term disability policies will not cover medical expenses incurred while outside of the United States. Verify the coverage details of your insurance policy before arranging to get surgery in a foreign country.
What to do if you need short-term disability insurance after an elective surgery
In order to file a claim for short-term disability insurance, you will need to gather the following documents: a claim form and medical documentation attesting to your inability to work as a result of your disability. You should also include a rough estimate of the time you will be unemployed in this letter, as many plans need it.
Inquire with your employer regarding the claim filing process if you are a covered employee under an employer-provided plan. In addition to paid and, if applicable, unpaid time off under the Family Medical Leave Act (FMLA), many companies have policies on the utilization of short-term disability.
Verify the claim-filing procedures in your home state if you are a resident of a state that has its own disability insurance program.
If you’re getting surgery, is it a good idea to get short-term disability insurance?
Many financial counselors advise against purchasing short-term disability insurance, even when it is privately accessible. You pay a lot of money up-front for a very small payoff (80% of your earnings for a defined term that could be three months or a year). When it comes to short-term disabilities or illnesses, like recovering from surgery, self-insuring (i.e., saving money in an emergency fund) tends to be the best option for many people.
There are restrictions and exclusions for existing medical conditions in many privately bought short-term disability insurance policies. If you’ve had medical attention for an injury or illness within the last year, your insurance may refuse to pay for any claims related to that condition, including any necessary operations.
