Out of Network - What do we do now?

If the concern is an "emergency" that would require immediate attention, it is my understanding the best step is to go to the emergency department. Any visit to an emergency department would fall under the medical portion of your insurance.

I thank you all for your responses, as with most of us it is not the office visit that concerns us it's what to do in case of an emergency. I was told by BCBS to try and go to Croizer in PA if possible. I live 5 min from Christiana so if I go to Christiana and BCBS determins I had time to go to Croizer does that mean I will be stuck with the bill. This is crazy. I even talked to my primary care physician and she was clueless as to what I would do, I told her I would be calling her first and she would have to make the best medical decision for me. I think we all need to call BCBS, CHRIAS, our primary care physicians, St. Francis and Christiana Hospital and find out what our options are. Maybe if we make enough stink about this something positive will happen and we need to share our finding with everyone on the forum. Don't doctors take a pledge to do no patient no harm, well this isn't helping any of us.

Hi! My name is Pat Foster and I am the Bariatric Coordinator working with Dr.Leon Katz at Crozer-Chester Medical Center. I would like to clarify the agreement between Dr.Katz and BC/BS of Delaware. Dr. Katz will accept all PRE-OP patients who are no longer able to continue at CHRIAS. However, he is not accepting POST-OP patients. The reason is simple- If you should develop a surgical emergency, it is in your BEST INTEREST to be treated by the surgeon who did your surgery. In the case of a sudden and severe emergency, you should go to ANY Emergency Room (including Christiana) and they are obligated to treat you and insurance will cover under those cir****tances. For routine labs, your PCP can order the usual panel (complete metabolic profile, lipid profile, CBC, FETIBC, B12 level, Folate and Prealbumin) to monitor you on a long-term basis. The recommended intervals are 3mos, 6 months, 12 months then yearly thereafter. For routine medical follow-up, you would need to use your out-of-network benefit to continue seeing your doctor from Christiana for lap band adjustment etc.... I understand that not everyone has OON benefit, so you might want to discuss that issue with BC/BS directly. You should continue to attend support groups (you are all welcome to join us at Crozer- It is the 4th Wednesday of the month 7PM-9PM in the NE Conference Room#2) I hope this has been of some help. I am a bariatric patient myself (4 years out- down 140 lbs with a BMI of 22 so I certainly understand your issues and concerns. If I can be of any further assistance, feel free to call me at 610-872-2000. Pat

Pat, Thanks for putting this on the notice board, it will be quite helpful for alot of us.

Hi Linda We are HAPPY to welcome all to our program. I gave an educational session at Crozer last night and entertained the Delaware crowd!! Despite a tooth abcess the show went on! Thanks to all who attended... As we are relocating our practice to a new building on campus, we have to ask that any POST-OP Christiana patients wishing to make appointments to see Dr Katz (610-872-2000) make them for after MARCH 1... I realize this is a delay from our previous projection, but we want to give you the best attention possible! Thanks Pat

I for one WILL utilize Christiana in an emergency and WILL expect my insurance to pay for ALL and ANY future treatments. For appoximately 16 months ,3 surgeries, 4 inpatient stays, BC/BS PPO has paid in excess of 100 thousand dollars and are expected to pay pending charges for recent visits per BC/BS. I have contacted my Administrator for my Employment where I work for the Largest Medical Equipment Company worldwide to make them aware of this situation. To their knowledge without me leaving the USA I am in-network simple. If it was going to be difficult I would of certainly of went where I work in Philadelphia with surgeons I work with and know (would of gotten the Professional discount) but NO I choose CHRIAS and Christiana because of their reputations in the Bariatric Community and locallity. HMMMM What was I thinking..........................