Surface Hippy Home       Contact Patricia Walter

« previous next »
Pages: [1]   Go Down

Author Topic: Getting in network coverage for out of network surgeon  (Read 461 times)

0 Members and 1 Guest are viewing this topic.

lv

  • Newbie
  • *
  • Posts: 2
Getting in network coverage for out of network surgeon
« on: September 30, 2012, 08:36:38 PM »
Hi,

I am writing on behalf of my husband who needs a hip resurfacing.  We live in Albuquerque and have Presbyterian insurance which only covers for surgeons in New Mexico.  There is no one here that is routinely doing resurfacing that we would feel comfortable going to .  We are going to make an appt with Dr. Rector in Boulder. How do you or has anyone been able to get their insurance to give you in network benefits for out of network surgeon in this situation.  There are surgeons here but they are not doing these surgeries with any regularity.

Also I am trying to get approval for all of this before we have the surgery. Has anyone done this?

Any thoughts/advice would be greatly appreciated.

Thanks

Lori
Logged

hernanu

  • Hero Member
  • *****
  • Posts: 2973
Re: Getting in network coverage for out of network surgeon
« Reply #1 on: October 01, 2012, 07:12:34 AM »
HI Lori, welcome to the site. What a great thing you're doing to help him out!

I had in network coverage, so I will let others that had to chase that down for themselves answer you. I assume that if a service is not available in network, that they would try to accommodate your husband's needs.

I would discuss this with Dr. Rector's office, I would assume they have some information on how to proceed, since they would have dealt with this situation before.

Welcome again, you're doing a good thing.
Logged
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Tin Soldier

  • Hero Member
  • *****
  • Posts: 1124
Re: Getting in network coverage for out of network surgeon
« Reply #2 on: October 01, 2012, 12:56:47 PM »
That's a good point about talking to the surgeon's office.  Rector is pretty well known and I bet they see a lot of out-of-network patients and they would be able to provide you with some direction. 

My surgeon was in network, surprisingly.  Although this year he is not, so my followup visit was a little more costly than I expected.  I would do everything you can to go to a surgeon like Rector.  I guess I would worry that if one were to stick with their in-plan and local ortho, they might not get the best results.  With HR, surgeon experience is very important.   Good luck. 
Logged
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

lv

  • Newbie
  • *
  • Posts: 2
Re: Getting in network coverage for out of network surgeon
« Reply #3 on: October 03, 2012, 05:14:47 PM »
Thanks for the responses.  I talked to Dr. Rectors insurance person and she was really helpful.  I have to wait until 30 days before surgery date to do any type of authorization so will keep my fingers crossed.  My husband has an apt Nov 29 and will hopefully schedule surgery sometime in February.

Lori
Logged

Hip Talk About Hip Resurfacing

Re: Getting in network coverage for out of network surgeon
« Reply #3 on: October 03, 2012, 05:14:47 PM »
Pages: [1]   Go Up
« previous next »
 

Advertisement

Dr. Gross Cementless Hip Resurfacing Dr. Kusuma Hip Resurfacing Surgeon


View My Stats

The opinions expressed on Hip Talk belong to each individual member. Patricia Walter is the Webmaster/Owner of Surface Hippy® . She is not a doctor or medically trained. She provides information about hip resurfacing and expresses her opinion about many hip resurfacing topics. She does not provide medical advice since only a qualified hip resurfacing surgeon can provide a patient with medical advice.

Hip Talk Moderation

Authority

The Hip Talk Discussion Group or forum is moderated on a Daily basis.
The moderators and administrators are volunteers. Patricia Walter and obxpelican.

The moderators and forum members are not regarded as health professionals.

Complementarity

The information provided on this forum is designed to support, not replace, the direct relationship between patients and health professionals.

Privacy

We remind you that any message can be read, used, reproduced and cited by all.
You do have the option to delete your messages. However, under exceptional circumstances, you can contact the moderators to do so. Thus, please take care regarding the information that you post.

Messages

The moderators and members should conduct themselves at all times with respect and honesty.

By using our forums, you agree to post information that is true and correct to the best of your knowledge and is of your personal experience. If the information you post is not personal experience, we request you to provide sources (references, links, etc..) whenever it is relevant and possible.

You are not allowed to post advertisements, whether in the form of text links or banners, for example.

Please keep your comments positive and polite. If you have a disagreement with another forum member, moderator or the site owner; please use the the private message feature of this forum or email the member. We try to avoid emotional conflicts on the discussion group and we will do so by removing posts and banning those that cause problems.

The moderators reserve the right to delete any messsages deemed inappropriate without notifying the author. In cases of abuse, the moderators reserve the right to ban a member of the forum. In both instances, an explanation will be provided if user requests.

Last date of modification: 10/26/2012