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CAH127
LIF Adult
Member since 7/07 1694 total posts
Name:
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Has anyone not had out of network insurance and fought to see a doctor out of network?
Has anyone not had out of network insurance, such as an HMO and fought to get coverage for a doctor out of network?
Message edited 3/24/2009 12:16:11 PM.
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Posted 3/24/09 12:15 PM  |
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Peainapod
Peanuts are here!
Member since 1/09 13591 total posts
Name:
Diana
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
i was not successful when i had aetna hmo.
they suck.
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| Posted 3/24/09 12:18 PM |
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Ophelia
she's baaccckkkk ;)
Member since 5/06 23378 total posts
Name:
remember, when Gulliver traveled....
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
there are very limited circumstances when you will win this battle.
generally they are in emergent, hopsital situations...or when this is the only doctor in the world with the kind of speciality/experience you need.
good luck.
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| Posted 3/24/09 12:20 PM |
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MrsPJB2007
MBA at your service!
Member since 7/06 12020 total posts
Name:
MJ
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
my mother had to do this when she was in the ER and apparently the doctor that treated her was out of network, even though she was at a hospital that accepted her coverage.
she received a bill from the actual doctor -- and was told by her insurance that he was not part of their actual network. she had to fight it with them because they were trying to say she should have ASKED for a doc in her network.
um she's doubled over in pain at 3 am and can barely speak and she has to stop the doc who is treating her if they are in network or not?
usually the situation has to be an emergency or you have to prove that this particular doctor is someone that you MUST use because of their expertise and such. but its not easy
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| Posted 3/24/09 12:22 PM |
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Kathy116
Hey baby!
Member since 6/05 1855 total posts
Name:
me
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
Posted by Ophelia
there are very limited circumstances when you will win this battle.
generally they are in emergent, hopsital situations...or when this is the only doctor in the world with the kind of speciality/experience you need.
good luck.
WIth my old insurance that was basically the case....I had to show that there were no other MDs who could treat me within a 40 or 50 mile radius. It was a loosing battle.
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| Posted 3/24/09 12:34 PM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
My mom had a brain tumor years ago with Aetna HMO. We went to a doc in Stony Brook who was the best doc the insurance company could recommend for her type of tumor.
He was incompetant. We left there devastated at the thought that he never performed that surgery before.
Our family physician called the insurance company and got them to allow us to go out of network to a doctor who had the expertise.
Basically it was put that if their doctor messed up they would be responsible for the after care for my brain damaged mother for the rest of her life. or worse, her death. They relented...we used a fabulous doc out of network and not one cent came out of pocket.
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| Posted 3/24/09 2:12 PM |
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jana
LIF Adult
Member since 3/06 1134 total posts
Name:
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Re: Has anyone not had out of network insurance and fought to see a doctor out of network?
Yep..lost the battle with the insurance co after 4 yrs of back/forth fighting & tons of paperwork. Ended up paying 35 grand out of pocket.
Good Luck.
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| Posted 3/25/09 12:30 AM |
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