Out of State insurance approval advice? BCBS GA POS wants to go to R.I. for HR

[atl_heidibug]

I've hit a snag with my insurance company. Apparently, I must give an explanation as to why I want to go out of state and not use Georgia's services. There are about nine doctors on the Hip Resurfacing list in GA now that BCBS wants me to use, however, I found a doctor in Rhode Island that I feel comfortable with, is very skilled and has done well over 200 surgeries. Plus, located close to my family.

I'm now in a holding pattern waiting for BCBS to send me a "Determination Letter".
I'm ready to hear the word "DENIED".

Any advice on a appeal letter for this one if needed?

cj

[karenj_m]

Hi CJ:
I'm just trying to figure out if you live in Georgia, why would you go to RI to a doctor who has done 200 or so resurfacings, when you can go to South Carolina to a doctor that's now done about 1800 resurfacings?

www.grossortho.com

Dr. Gross

PS: I'm originally from Prov. RI by the way ;) I now live in northern NY. My sister who lives in Cranston, RI, flew up to NY to assist me for the first week, since my partner was working that week...it was a huge help.


Just a thought, you might have a better arguement of wanting to go to a more experienced surgeon as far as the insurance companies are concerned (if Georgia surgeons don't have that high of a count)...and Dr. Gross has contracts with BC/BS.

Resurfacing is a difficult surgery, and placement of the two parts is essential to you long term.