How to get reimbursed from insurance?

After my 3rd consult ive found my surgeon. Wohoo.. Everything is great except one thing. They do participate with insurance but not blue cross. I know no guarentees that theyll give it the ok but i would like to try anyway if not ill just finance. So im wondering do i go ahead and take out the loan and submit after surgery. Or should i try to precert and then send claim after surgery?

Call your insurance company and find out how a claim is handled for a "non-particpating" doctor or hospital. It will completely depend on the specific policy you have.  For instance -- I have BCBS PPO and if I go to a doctor that accepts my type of insurance my claims are covered as specified in my plan.  If I go to a doctor that doesn't participate with my plan then I have to pay an "out-of-network" sanction which is anywhere from 20% to 50%.  Example:  I went to a doctor that was out of network and his claim was $180. Besides my co=pay of $20 for the office visit, I had to pay an additional 20% of the bill ($32), then BCBS covered the remainder (after they adjusted for reasonable/customary). so definitely do some research about your specific plan before you make plans to pay for it on your own.  You might be pleasantly surprised.  Better to be armed with knowledge then to assume wrong. Pam