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elise_flowerchild | Which doctor do I call? |
I went to the doctor. He referred me to a urogynecologist that is not part of my PPO Plan. My Plan (ChoiceCare Network) doesn't even have a section for "urogynecologist." When I looked up my health insurance policy, it says I have to pay the difference above the "usual and customary fee" for that service. So what should I do? Call my company and ask what a "customary fee" is? Should I call my doctor and ask for a different referral? Or should I talked to the referred doctor and see if they can still take me?
Convoluted, I know. |
 |
 
Natasha K
 |
1. Sit down and write out all of your questions
like: Can I go to this doctor?
Can you give me a referral of someone I can go to?
Would it cost extra and how much if I go out of network and
is this doc. out of network, etc...
2. No matter what, Call your insurance company.... and talk to a
person. Be really nice and ask them for help. Ask them
EVERYTHING on your list and then some.
3. See if you can work out a deal with your doctor, maybe they will
only take your insurance money and not charge YOU for
anything...don't be worried about feeling wierd for asking, you don't
know if you don't ask....
4. Get medical attention, health is VERY important.
GOOD LUCK!!! |
|
bud68
|
Ask your doctor for an "in-network" referral. If he is says that this out-of-network referral is medically necessary, you need to obtain prior approval from your insurance. |
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reddaisy
|
sometimes the doctor that isn't in your plan will except what the insurance pays.
A new patient is better then no patient. |
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Patricia C
 |
If I were you I would ask my family doctor to refer me to a urologist if you have a urinary tract infection or something similar. I'm sure your insurance would cover that. |
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MARK B
 |
I have ever met this kind of situation before,here http://www.healthinsurance-onlinetips.info/health-insurance-for-free.htm is the resource I found useful though.
|
|
KG Mom
|
1. This is not technically a speciality as recognized by the AMA (which is what the insurance companies are going to list their docs as). Its a doc who is an ob/gyn who has a further specialty for pelvic floor dysfunction
2. Contact your doc office first and speak to someone in billing (who deals with the insurance companies). See if they have a suggestion for someone else who is in the network with this speciality.
3. Take a look at this website. http://www.mypelvichealth.org/FindaProvider/tabid/75/Default.aspx
You should be able to find docs in your area who have gone through this 3 year course (shouldn't the AMA be recognizing this by now?). See if they are in your network.
4. If you cannot find someone on your own in the network who has this, then call your insurance company. In some states, the laws require the companies to cover it as in network visit/procedure if it is not available as in network benefit. And don't take a "no" from the first person who answers. If they say they won't cover it, ask them what the appeal process is within the company or "do I have to appeal direct to the insurance commissioner"
Good luck and I hope everything turns out ok!
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