might have to switch doctors

PCP to deal with
referrals to get
having to have a PCP do my gyn exams (YUCK)
not being able to see some doctors at all as opposed to paying a bit more.
diets to deal with
denials to worry about



I have never dealt with any of those issues you mentioned. I have my GYN of my choice thank goodness. The only thing I need to do is get referrals from my pcp to see the specialists. I don't need referrals for a gyn. 

I can totally understand your frustration though.

Good luck with everything.

I have to admit I am less than impressed as well...  So far under our insurance I have found ONE neurologist not covered, so I pay 20% of the cost if I see him...  (About $70 per visit) and for surgery I pay zip, St. Agnes is covered for us, so the anesthesiologist is covered fully since they bill under the hospital (at least this was what my insurance and the pre registration staff have explained... If NOT, I won't know until after surgery...

you better check that!  I have always forgotten about the anesthesia for surgery and always get a huge surprise when I get that bill.  

the anesthesiologists are doctors or CRNA that work at the hospital just LIKE the OTHER DOCTORS  they have 'privlidges' with the hospital but they are not PART of the HOSPITAL BILL.

I am going to call them tomorrow... If I forget, remind me LOL

I will remind you.


and I  am sorry if anyone thinks i'm being difficult.


truthfully I think that ANY coverage we get from insurance is better than no coverage.


it is what it is... .and i guess i feel defensive about it.. it's almost like you all telling me what a horrible mistake I made in a husband and you are so glad you are not married to  a man like him who's so NOT as good as your husband...

I don't think you are being difficult at all!!

I am glad to know about this, I had no idea it would be billed seperately! And now I want to know more... While I will pay it if I have to, it irks me that the hospital nor my insurance ever mentioned it before!  Mainly I think it is bull because it is not like we have a choice in our provider - I would go in network if I could... but since I have no choice in the matter...  They shouldn't be allowed to charge me more!

My husband is a pain the ass :)  I love him to death, but I do wish he at least would consider the surgery and helping me more in getting to mine.  Yours at least is trying, even if it is somewhat against his will LOL

Nessa OMG thats to much if you are on a budget... I hope you dont have to switch docs. Does DVR go to another Hosp? Maybe if he did things would be different. Dont you like the anestologist? I know I spelled it wrong sorry. Maybe if you meet the guy or ask DVR his opinion of him you would fell better..


                                                             Julie

oh we have the money to cover it.   that's not the issue.  I have a huge budget for this. 

DH will not switch doctors.  it has nothin to do with the hospital or DVR really.  maybe i can get him to use one of the two that are PP. 

i have no idea who the anesthesioligist is.   in fact, in every surgery i've ever had i had NO SAY in it.  we took who the doctor was comfortable with.  

i just need the doctor to use the PP  and if he does not want to, I have no choice but to pay the $800 each.    

i mean if you were a doc who billed 1200 for a procedure and could get 800 from me or only the 400 from the insurance which would you do?

ok i'm not getting this out clearly....    this has NOTHING to do with WLS.  it has to do with ANY kind of surgery.  it's a standard thing.

IN fact here is their example.:

Here is an example: You have coverage under Standard Option (we do) and go into a Preferred hospital for surgery. (we are) During surgery, you receive the services of a Non-participating anesthesiologist. (which is probably what will happen as this is what almost ALWAYS happens most anesthesioloists are NOT PP for some reason mabye because they cut a deal to share with the doctor who has to take 17k for a surgery he bills 50k for) Under Standard Option, members pay the amount billed for services provided in Preferred facilities by Non-participating anesthesiologists, up to a maximum copayment amount of $800 per anesthetist per day (no deductible or coinsurance amounts apply).  For Preferred provider services, members pay only a coinsurance amount of 15% of the Preferred provider allowance after meeting the $300 calendar year deductible. 


In this example, the Non-participating anesthesiologist charges $1,200 for his/her services.  Our Preferred provider allowance for those services is $400.  For the Non-preferred anesthesiologist’s services, you would be responsible for paying the full $800 copayment amount.  If you instead received services from a Preferred anesthesiologist, you would pay only 15% of the $400 allowance (after meeting your deductible), or $60, resulting in a savings to you of $740 ($800 - $60 = $740). 



has nothing to do with WLS
has nothing to do with the current doctor (or any other doctor)
has to do with the fact that it's nearly impossible to get a doctor to use a PP anethesiologist because Doctors do not like to be told who they can and cannot work with.

we're screwed. 

Sorry to hear about the anesthesiologist issues!  2K is alot of money, especially in today's society!!

Thinking good thoughts for ya!
Heather