surgery-finding in-network providers

[mrsklamc]

So, as mentioned in a previous post, I have thyroid cancer and need to have a thyroidectomy.

I have seen some nasty insurance hijinks stories on the budget board over the years- how do I make sure this doesn't happen to me?

I have a great in-network surgeon, but how do I find out about, say, the anesthesiologist? Do I start with the doctor's office? Ask the surgery center? Or start with the insurance company?

Thanks!

 

[aka-mad4themouse]

We're in an HMO and DS17 had surgery last March. The surgeon's office took care of all of that. Same thing for DD19's impending wisdom tooth surgery. And believe me when I say that most of the time, finding out who I can and cannot see under my plan is a nightmare! Don't get me started on what imaging center, posiatrist or PT facility I can used based on who my primary is capitated to!

I would speak with whomever it is that works with insurance at your surgeon's office. They would be the ones most familiar with your insurance plan and its coverage. They can put your worries at ease.

Keeping good thoughts for you. The insurance side of things should be the furthest from your mind right now but I understand your concerns.

 

[akcire]

Talk to the scheduling nurse, or better yet talk to her and send her an email. She will coordinate all the people, places, etc for your surgery. Be very clear that you must have all in network providers.

The scheduling nurse will be your surgeons employee, or in his practice group at the hospital.

 

[mrsklamc]

Thanks! I know I shouldn't worry about the finances too much but I want to *keep* as much of my emergency fund as possible. I have even heard that different hospitals charge different amounts for the same surgery, and that if you ask they may give you a discount for paying cash up front before you leave! It's almost like buying a used car!

 

[DebMcDonald]

I work at a very large hospital in Boston, and everyone at our hospital takes all the same insurance companies, everyone uses the same billing office, but each group bills separately through our main billing office, so you could start with the main billing office and speak to them.

 

[aka-mad4themouse]

Thanks! I know I shouldn't worry about the finances too much but I want to *keep* as much of my emergency fund as possible. I have even heard that different hospitals charge different amounts for the same surgery, and that if you ask they may give you a discount for paying cash up front before you leave! It's almost like buying a used car!

If you're in an HMO or PPO (which I'm guessing that you are since you are referring to "in network" providers), the participating doctors and facilities must accept assignment from the insurance company as per their contract. You will not be required to pay anything above your deductible and copay unless you have not followed your insurance company's guidelines.

 

[malibuconlee]

Not sure how all insurance companies work, but here's my story.

Had a c-section (unplanned) last year. There is only one hospital in the town I lived in at the time. It was in network for my insurance. Used an OB from the only OB practice in town - also in-network.

The anesthesia practice (CRNA's not Anesthesiologists) in town apparently was NOT in-network. I got the EOB saying as much. Called the insurance company and explained they were the only show in town and it was re-processed as in-network. The claims person I spoke with said it should have been that way in the first place because I used an in-network hospital and had no other choices. The only difference being they didn't have negotiated rates.

Good luck - dealing with insurance is a pain!!