Bad news from my doctor's office

Got a call from my doctor's office today that the new doctor's credentialing has not been approved or completed by Aetna yet.  My surgery is in 13 days!!  They said it could be 3 more months.  Wait, what???  He is considered out of networ****il then which means out of pocket for me.

I'm at a lost for words and very, very sad.  Had I known, I could have been saving up, but now I'm scrambling.  I HAVE to have surgery on the 25th.  I'm flying my mom in to help and have arranged PTO at work.  Not to mention the delightful liquid diet I started yesterday. LOL

Just need to vent.  Please keep your fingers crossed that this will all work out.

Maybe doctor will still do it and get paid when it comes through good luck i know how you feel..next option is pay for it up front and then get reimbursed by doctor when he receives payment..

I would ask for assurance IN WRITING from insurance company and surgeon's office to confirm that this would happen before making any assumptions.

How much would it cost to change your mom's plane ticket? Worst case, a few hundred bucks?

The out-of-pocket cost for surgery could be as much as $25k. The airline change fee is PEANUTS in comparison to the amount you may have to pay without an in-network provider.

Yeah, it sucks to be postponed. But I'm not sure if it's worth tens of thousands of dollars to have surgery 3 months sooner.

This is common for Aetna.   When contracts are signed, they have to have credentials on the physician verified each time.  While it is a pain the butt, it does put a red flag in the system that the surgeon is currently not contracted with them.  However, once the credentialing is done, they retro that and will pay for any claims that are outstanding.     The surgeon may have been contracted when you started the process, but it expired and required new credentialing before they will start a new contract.  

However, because this is an elective surgery, it could pose a problem for them to get reimbursement in a timely manner and could pursue you for payment of services, after the fact.    I am NOT saying this is what will happen, but like some suggested, I would definitely get something in writing or some form of assurance from the surgeons office that you will not be billed for the surgery in full.     Offices that deal with this on a regular basis will tell you exactly the above, this is routine and the ins will retro the contracted date to the day after the expired one, which will mean you are ok.   

Keeping my fingers crossed for you! 

Is this an Aetna PPO/POS type of plan where out of network is still covered but at a higher copay, or HMO where they don't cover him at all? If it's a PPO where he is still covered, talk to his office about the situation - they may be able to make some fee adjustments under the cir****tances.

Also, how have your other medical expenses been this year - are you at all close to the max out of pocket level for your plan? My surgeon was out of network for Aetna (though the hospital and other costs were in network,) but by the time Aetna got around to paying him, we had hit the max for the year and his fee was covered 100%.

Before you commit to paying out of pocket, you might want to find out how much it's going to be.  It could run you $25K.

I understand the desire to have this done as soon as possible, but I would recommend that you cover all your bases to avoid incurring a substantial debt from surgery.   If your insurance covers it, then you're better off making sure that your surgeon is in network and get a commitment letter from your carrier to avoid financial problems down the road.

Sorry about the screw up.  It's not your fault, but you're the one who has to deal with the consequences.