Can I get EDD SDI benefits for elective surgery performed outside the US?

i had a friend who got denied for dental work in mexico last year, edd said something about the doctor not being "qualified" even tho he was a real dentist.

This is an interesting question. According to EDD's regulations, the medical provider must complete and sign the medical certification portion of the DE 2501 claim form. The provider needs to be licensed/certified by the state where they practice, but there's nothing explicitly prohibiting foreign providers. However, I've worked with clients on similar cases, and there are a few practical challenges: 1. The foreign doctor must complete the standard EDD medical certification form (not their own country's equivalent) 2. All documentation must be in English or professionally translated 3. The doctor must include their medical license number and contact information 4. EDD may take longer to verify foreign credentials 5. You'll likely need to provide additional documentation about the medical necessity of the procedure I'd recommend having your US primary care doctor co-sign or provide supplemental documentation supporting the medical necessity of the procedure. This gives EDD a US-based medical provider they can easily contact if needed.

Just want to add my 2 cents - I had a hysterectomy in Canada (I live near the border) and EDD approved my claim, but it took FOREVER. They kept asking for more documentation and called my doctor multiple times. Ended up taking 6 weeks to get my first payment when it should have been like 2 weeks. Super stressful waiting that long with no income!

I work in HR and have helped employees navigate this exact situation. The key is preparation. Here's what you need: 1. Have your Mexican surgeon complete the medical portion of the DE 2501 form - make sure they include their medical license number and contact details 2. Get a certified English translation of any supporting documents not in English 3. Ask your PCP to write a letter confirming the medical necessity of the procedure (mention the rashes and back pain specifically) 4. File your claim online through SDI Online as soon as possible after surgery 5. Keep copies of EVERYTHING The big issue isn't usually the foreign doctor - it's proving medical necessity for what EDD might view as cosmetic surgery. That's why documentation from your regular doctor about the skin issues is crucial.

Good luck trying to talk to anyone at EDD about this beforehand! I spent 3 WEEKS trying to get someone on the phone about my claim. Finally used a service called Claimyr (claimyr.com) that got me through to a real EDD rep in 20 minutes. They have a video showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd Worth it when you need answers about something complicated like foreign doctors. The rep I talked to said they do accept foreign providers but they have extra verification steps.

wait I'm confused... if the surgery is elective why would they pay disability?? I thought disability was only for like if you get hurt at work or have a baby

I've been through this nightmare with EDD. Even with perfect documentation, they'll probably deny your claim initially because it's a foreign doctor AND elective surgery - double red flags for them. Be prepared to appeal and provide mountains of medical records. They forced me to see their own doctor for a second opinion before they would pay my claim for surgery I had in Thailand. The whole system is designed to wear you down so you'll give up. If you're counting on this money, have a backup plan because it might take MONTHS to get approved.

One more important tip: make sure your employer fills out their portion of the DE 2501 form BEFORE you leave for Mexico. You don't want to be trying to coordinate that while you're recovering abroad. Also, double-check that your Mexican surgeon knows exactly how to complete the medical certification - any mistakes could cause significant delays.

Congrats on the weight loss!! I lost 130lbs a few years ago and also had the extra skin issues. It's crazy how insurance considers it "cosmetic" when it causes actual medical problems. I didn't have the surgery yet (saving up) but I'm curious how your experience goes. Please update us after!

I went through something similar with EDD for surgery in Costa Rica back in 2022. The foreign doctor issue is definitely manageable, but you need to be super organized about it. A few things that helped me: - I had my surgeon's office translate ALL documents into English before I even left the country (don't rely on Google Translate - get certified translations) - Made sure my surgeon understood they needed to use the exact wording from the DE 2501 form when describing my disability and work restrictions - Got a letter from my US doctor beforehand stating the surgery was medically necessary (sounds like you have legitimate medical reasons with the rashes and back pain) The whole process took about 4 weeks for approval, which wasn't too bad. The key was having everything perfectly documented upfront. EDD seems to approve foreign claims when all the paperwork is correct - they just scrutinize it more heavily. One warning though: make sure your surgeon gives you VERY specific work restrictions (like "no lifting over 5 pounds, no bending, no standing for more than 30 minutes at a time"). Vague restrictions like "light duty" can cause problems.