The Surest health plan requires me to activate coverage for specific procedures, meaning after activation I’ll have 120 days to get the surgery done and not have the claims denied. What’s confusing is why the heck there’s a 120 day period if you can just reactivate the coverage after 120 days. I called the customer sevice line, and the rep told me that you only have 120 days to get that specific procedure done, then after that for the rest of your existence you cannot reactivate the coverage. This seemed absolutely bonkers to me because obviously you can reinjure yourself or need the same surgery done on the other side of your body. So I called back and a different rep said actually you can activate coverage for the same procedure after 120 days. Does anyone know what the truth is here? If you can reactivate coverage, then why do we even have a 120 day window? Seems utterly pointless to me
Are you referring to pre auths for the procedures?
No, this is different. Pre-authorization is when the doctor approves the surgery, which is required with any insurance plan. Separately, you need to use the Surest app to “activate” the specific procedure. Once activated, you’ll be covered after a 3-day waiting period if you have the surgery within 120 days (so, 123 days after clicking the button). It’s unclear why you need to “activate” coverage if you can just reactivate it after 120 days.
I didn’t realize Surest/Bind still offered the Flex plan. In many areas, they have switched to a capitation-style copay plan.
For many claims, you need both Prior Authorization and the Flex Option activated. You can find the details here: Prior Authorization Requirements for Surest Health Plans.
The process involves a mandatory 3-day waiting period. For example, if you activate it on Monday, the earliest you can have outpatient surgery is Thursday. This setup helps avoid the infinite loop issue.
Also, remember that Flex benefits come with additional premiums. If you accidentally turn it on and don’t turn it off within 3 days, you might end up owing a standard baseline price for 6 months to a year.
This still is the copay plan actually.
All Surest plans are copay, where you have no deductible and few out of pocket maximums.
The Flex plans have the add on services with corresponding surcharges to your premium.