Insurance snag

jodieshane · January 25, 2011, 07:00:28 PM

Hi, everyone. I'm scheduled for a bi-lat in Feb. with Dr. Gross in S. Carolina, and I'll be flying in from Arizona. When I began to research all of this it looked like Dr.Gross was the man. His cementless implants seem to be on the cutting edge. There's a catch, though. My insurance will not cover this "out of network" procedure. Now I have to basically do a sales pitch to my insurance company in order to get covered. Has anyone out there had a similar situation, and if so, how did you deal with it?
Thanks to all!

Shane

Dayton96 · January 26, 2011, 04:37:58 PM

Hi Shane,

Sorry to hear about your insurance problems. What insurance company do you use? Have you had it confirmed by Dr. Gross' office that they were unable to get you precertified?

Mac

jodieshane · January 27, 2011, 07:02:08 AM

Hi!
I'm Trying to figure this one out, but it seems there was a misunderstanding between my insurance and the people who work with Dr.Gross. Now it seems I am covered according to my insurance advocate. Arrrgh! My surgery is in 3 weeks and stuff like this starts to happen. Anyway, thanks for your reply. I'll keep my fingers crossed and continue full steam ahead.

Shane

Dayton96 · January 27, 2011, 07:14:51 AM

Good luck with the surgery. If it helps, I have Blue Cross/Blue Shield and I know it covers Dr. Gross.

Mac

BrianROC · January 27, 2011, 09:27:22 AM

Best of luck with your surgery. I had both hips resurfaced by Dr. Gross in early December. You will be in great hands.

newdog · January 27, 2011, 10:59:02 AM

That is really good news about the insurance. You will do O.K. You're in good hands.

Steve

obxpelican · January 27, 2011, 11:02:11 AM

If you call the hospital they can do a predetermination of your stay and your policy, then you will know what if at all you will owe.

Chuck

Quote from: jodieshane on January 27, 2011, 07:02:08 AM
Hi!
I'm Trying to figure this one out, but it seems there was a misunderstanding between my insurance and the people who work with Dr.Gross. Now it seems I am covered according to my insurance advocate. Arrrgh! My surgery is in 3 weeks and stuff like this starts to happen. Anyway, thanks for your reply. I'll keep my fingers crossed and continue full steam ahead.

Shane

FlbrkMike · January 27, 2011, 04:04:05 PM

My surgery is two weeks from tomorrow, and I have Blue Shield of California. I know that the hospital I will be going to is on the preferred provider list as is my surgeon, Dr. Ball. The anesthesiologists, however, work on a rotation so there's no way for me to find out about him/her until my pre-op meeting next week. A have to assume for now that everybody is covered, but I guess I can't really be sure until then.