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Author Topic: Getting in network coverage for out of network surgeon  (Read 5482 times)

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lv

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Getting in network coverage for out of network surgeon
« on: October 01, 2012, 03:36:38 AM »
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

hernanu

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Re: Getting in network coverage for out of network surgeon
« Reply #1 on: October 01, 2012, 02:12:34 PM »
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.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Tin Soldier

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Re: Getting in network coverage for out of network surgeon
« Reply #2 on: October 01, 2012, 07:56:47 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. 
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

lv

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Re: Getting in network coverage for out of network surgeon
« Reply #3 on: October 04, 2012, 12:14:47 AM »
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

 

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