One of the docs is out of network!!!!

I was so excited because Dr. Gorospe's office finally called and scheduled all of my appointments. I got on Aetna's website this morning to verify that everyone was in network and low and behold the pulmonologist is not! I called his office to double check and she said that iw ould have to pay $650 on the day that I see him. I know that this is the greatest thing that I will ever do but I am running out of funds. Between my copay to Gorospe and the sleep studies that wound up costing a small fortune I am not sure what to do. I am waiting for Gorospe's office to call me back so i can see if there is another doctor that I can use but I don't think so because it has to be a doctor associated with the hospital. I am sooooo stressed out. AGHHHHHHHHHHH!

I do not understand why the doc has to be associated with the hospital?  Rather the pulm...is  with the hsopital or not you should be able to see who your insurance will pay..
Good luck to ya

I agree. The doc should be who you pick. The records can be sent to the hospital. Dr. Walton is getting my labs from my PCP and information on my heart, from my heart doc....I hope you find more info from their office....Just flat out ask them why you can't go to one in your network as long as the results are faxed over to them. What if you had just had these tests done before deciding on this surgery....They would take the results of them...or most...Dr. Walton is.....Some times...it is a lack of communication on their part and if you push for answers...you can get them. Stand firm that you have to see one in your network.  To me....and what do I know...but as long as you meet the requirements for the surgery....Who cares how you get the requirements met or who treats you....Let us know...in the meantime...I'm praying for doors to open wide for you!! I am also praying that they will find favor for your request!!!
Sher

Dr. Gorospe isn't the only dr that requires that you see a certain pulmonologist.  Dr Katsis requires that as well. The reason they want the associated with the hospital is because they will follow you through your hospital stay.  It really isn't unreasonable they want the dr to be familiar with you and your conditions when he is following you. I have to see DR Worley and normally I see DR Bregman for my sleep apnea. I had my Records from Dr Bregman sent to dr worley. I understand the money issue, but I also he the dr's point of view too. Good luck getting it worked out.
Emily

I guess I don't see it....They will follow you for one day while in the hospital??? To me that is a money muncher!!  Sorry, that is how I feel...... I only saw my pulmonologist for 2 min to tell me to go get a sleep study at HIS sleep clinic He charged me 300. The sleep clinic  charged me 1300. Then they called me to set up another sleep study to set the cpap machine for another 1300 bucks...but also wanted me to pay for the machine  and mask too.....I flat didn't have it and had to find other routes. This was the only reason for the pulmonologist that I could see..I mean, if you have other issues then I understand...I just see it as a way for some doctors to keep the money in their own pockets without regard to the patients financial cir****tanses!! I know Dr. Walton requires a sleep study, but I  had had the one I had in May and at the request of my Cardiologist... I  had my  results faxed to Dr. Walton. I am assuming that he is accepting them along with the Cardio's stress test results. I haven't heard Dr. Walton require certain doctors to be a part of his requirements....I may be wrong and surprised! I hope not!!
I still would do some talking!!!

Don't get me wrong, I wish my Surgeon would have accepted my Pulm's reports, but he wouldn't. I don't know if it was a money thing or not. I just know I was required to see a certain dr too and even though I have seen him last year, I have to repeat it again this week because it is more than   a year old so I am going through it twice and it is costing me, but you jump through the hoops, right? I want the surgery and my surgeon won't budge on this. I defintely understand her plight.
emily

No, I know what you are saying...but it is for sure not fair to the patient! That of couse is just my opinion....I just see so much of it....When you have large deductibles or are self-pay it really sucks.  I know when they advertize a price...no mentions all these little visits to different people....I will play the Glad game here and say I am soooooo glad that Dr. Walton's office has accepted these reports and that I am 4 months away. I'd love it to be tomorrow...but 4 months is OK. Yes, we do jump through hoops to get this....only my problem is, I only jump after they tell me why?? As long as we all get there..that's all that matters! 

I ran into the same problem with Aetna and Dr. Britt. I had to pa the money but I had Gorospe's office call in a referral explaining why I had to go see him and I can file a claim to get some or even all of my money back. Make sure they do it before your scheduled appointment!

Good luck!

And I'm broke too. My $300 insurance deductble has turned into $1770.00 and counting...

Sorry Dr Britt is out of network for you, that crap just chaps my hide sometimes about insurance companies.  Dr Britt is a great man though and funny to boot.  He reminds me of Norm from Cheers.

OK..... I looked on the Bailey Medical Center website and there are 4 pulmonologists listed and DR. Britt is the only one that doesn't take Aetna. I called Dr. Gorospe's office and was told if I can find a pulmonologist that would do a report for "their program" and could get the results to Dr. Kirk 3 days before I see him on 10/14 that would be fine. The funny thing is that I am supposed to see Dr. Britt (the pulmonologist they referred me too) the same day I am scheduled to see Dr. Kirk...now how is that for getting records over 3 days in advance. Then she tells me that if there are complications after surgery Dr. Gorospe will most likely call Dr. Britt no matter who did my pre-evaluation. Now in my opinion if it is life or death call whoever the hell you want to....

The whole thing just seems screwey to me....the same thing happened with my sleep study but i found out too late. My $2000 surgery is more like $4000 at this point and I am tired of all of the shady "referrals". Is it just me or is it kinda wierd that they have these strict referrals...sounds like someone is getting a kickback if you ask me....