What Do You Mean It's Not Covered: Optional Coverage: Added Surgical Costs
COVERAGE FOR SURGERY, DIAGNOSTIC PROCEDURES, AND FRACTURES -- The benefit for a surgical operation, diagnostic procedure or fracture is based upon the Schedule of Operations. A certain percent is shown for each operation listed in the surgical schedule. We will pay up to this percent of the maximum surgical amount for that operation. The maximum surgical amount that will be paid for an insured person is stated on page EI2,5. Our payment will not exceed the surgeon's fee.
This is an optional coverage that provides benefits for the surgical procedures. Coverage only applies to each insured for whom it is shown in the policy schedule. When purchased, benefits for surgical and diagnostic procedures or treatment of fractures are based upon a Schedule of Operations. The maximum benefit is a dollar amount shown in the policy schedule. For individual procedures, percentages are shown in the Schedule of Operations. The most that the insurance company will pay for a given procedure is the applicable percentage times the maximum benefit amount, but payment will not exceed the actual fee charged. An example: You've purchased $10,000 of coverage for surgical procedures. You require surgery for removal of a kidney stone, a procedure for which 80 percent of the maximum benefit applies. If your surgeon charges $8,200 for the operation, the policy will pay $8,000 (the applicable percentage of the maximum benefit). If your surgeon charges $7,600 for the operation, the policy will pay $7,600 (the actual fee charged).
