Disability insurance and elective surgery

Recovery from medically necessary surgery is covered by short-term disability, but what qualifies depends on the nature of your surgery and your disability policy.

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Amanda Shih

Amanda Shih

Editor & Licensed Life Insurance Expert

Amanda Shih is a licensed life, disability, and health insurance expert and a former editor at Policygenius, where she covered life insurance and disability insurance. Her expertise has appeared in Slate, Lifehacker, Little Spoon, and J.D. Power.

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If you’re considering an elective surgery, you may have questions about whether a disability insurance policy can help you pay your bills while you’re recovering. Whether disability insurance can help you depends on the nature of your surgery and the nature of your disability insurance plan.

How short-term disability insurance works after surgery

Short-term disability insurance (STD) pays a percentage of your salary — usually 80% of your gross income — if you’re unable to work because of disability, such as an illness, accident, or recovery from necessary medical procedure, for a short period. If you experience a disability, you file a claim for benefits with your insurer.

The benefit period, which is the max amount of time that you can receive benefits, lasts from three months up to one year, depending on your policy. The elimination period, which is the time you have to wait between your diagnosis or injury and receiving benefits, is usually 1 to 14 days.

How short-term disability treats elective surgeries

You can qualify to receive benefits from short-term disability insurance after an accident or illness or to recover from surgeries that are medically necessary.

Each policy will have its own language detailing what “medically necessary” means, but generally, a qualifying procedure is both prescribed by your doctor as required treatment for an injury or illness and appropriate according to generally accepted standards of medicine.

Each policy will also have its own list of exclusions and limitations.

These may include pre-existing conditions (generally defined as illnesses or injuries you’ve been treated for in the past year), self-inflicted injuries (including suicide attempts), injuries or illnesses incurred due to the illegal use of drugs or alcohol (including injuries from drunk driving accidents), and more, depending on your policy.

Short-term disability insurance and plastic surgery

Short-term disability insurance companies differentiate between reconstructive surgery and cosmetic surgery when evaluating whether to pay benefits. Many policies have language that the procedure must be to restore physical function in order to qualify.

Cosmetic surgeries are not generally covered as they are not seen as medically necessary. But there are circumstances — like after treatment from breast cancer or to alleviate chronic back pain — where breast augmentation, reduction and reconstruction surgeries may be covered.

Reconstructive surgeries, such as craniofacial reconstruction after an accident, are generally deemed medically necessary and are also covered.

Short-term disability and weight loss surgery

Many carriers will approve short-term disability claims for weight-loss surgeries, including gastric bypass, bariatric, and lap band surgeries, if the procedures are considered medically necessary to alleviate a physical symptom.

For example, a gastric bypass to address a physical symptom like respiratory issues would likely be covered. The same procedure to improve physical appearance would not be covered. Abdominoplasty, more commonly called a “tummy tuck,” are more rarely covered and medical necessity must be proven.

Short-term disability insurance and dental surgery

Recovery from dental surgeries may or may not be recovered, depending on your plan. Some policies exclude dental surgeries, such as the removal of a wisdom tooth or wisdom teeth, from coverage

If a surgery is required after an injury or accident, it will likely be covered.

Short-term disability and orthopedic surgery

Surgeries to alleviate pain in the hips, knees, feet, ankles, shoulders, elbows, hands, and spine are often medically necessary, and therefore qualify for benefits under your short-term disability policy. For example, knee replacements, hip replacements, and rotator cuff surgeries are commonly medically necessary orthopedic surgeries.

It’s important to note, however, that surgeries to treat injuries sustained while working are not covered by short-term disability. At-work injuries are covered by workers compensation.

Short-term disability insurance and medical tourism

Some Americans choose to travel to foreign countries for medical procedures and surgeries because costs may be lower.

However, many short-term disability policies won’t pay benefits if you’re receiving medical treatment outside of the U.S. If you’re planning to get surgery abroad, check your policy’s limitations and exclusions.

How to make a short-term disability insurance claim after elective surgery

When you make a short-term disability insurance claim, you’ll need to submit a claim form and information from your healthcare provider stating that you're unable to work due to a disability. Many plans will want this letter to also provide an estimate of how long you will be out of work.

If you are an employee under an employer-provided plan, ask your employer about how to file a claim. Many employers have policies about how to use short-term disability in conjunction and in addition to paid time off and, if applicable, unpaid time off through the Family Medical Leave Act (FMLA).

If you live in a state with its own disability insurance program, check your state’s guidelines for filing for claims.

Should you buy short-term disability insurance if you’re planning surgery?

Though short-term disability insurance is available to be purchased privately, many financial advisors don’t recommend it. The premiums are high for what ends up being a low potential payout (80% of your salary, for a set period that may be up to three months or one year). For many people, self-insuring (that is, putting money in an emergency fund) is often a better way to prepare for short-term illnesses and disabilities, like recovering from surgery.

Additionally, many privately purchased short-term disability insurance plans include limitations and exclusions for pre-existing conditions. In many cases, this means that if you’ve been treated for an injury or illness in the past year, claims relating to that illness, including surgeries to treat it, wouldn’t be covered.

Author

Editor & Licensed Life Insurance Expert

Amanda Shih

Editor & Licensed Life Insurance Expert

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Amanda Shih is a licensed life, disability, and health insurance expert and a former editor at Policygenius, where she covered life insurance and disability insurance. Her expertise has appeared in Slate, Lifehacker, Little Spoon, and J.D. Power.

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