Can't find in-network surgeon

My insurance covers DS and VSG- I self paid for the VSG because I do not have any comorbids or documented medical history.

My husband does- diabetes, HBP, depression, apnea ets etc etc and has been very good about going to the doctor and documenting his care. I know I could get him approved. My problem is I can not find a doctor in Iowa that does VSG or DS.

Out of network providers are covered at 0%- has any one had any luck getting insurance to cover out of network surgeons if no surgeons are available in network?

 

Does that make sense?

 

Who is your insurance carrier and is it an HMO, PPO...?

 What network are you in? 

You might want to post this over on the DS board. Insurance issues come up all the time and perhaps someone from your neck of the woods can help.

  Also, there is an excellent list of DS surgeons at duodenalswitch.com. I don't know offhand of anyone in your state, but there are definitely Ds surgeons in Minn and elsewhere in the medwest for your husband to consider. Often they have people on their staff that assist with insurance issues.

 

Larra

My insurance is Coventry of Iowa- open PPO

I found the list of DS surgeons. And have called every major gasto and every bariatric surgeon

in Iowa. I am just at the beginning of this whole process

 

Thanks for your responses- I will try the DS board

Maybe if his PCP refers him to a particular surgeon they will pay. Maybe they can write a letter of necessity and include some thing about that there isn't an in-network doc and therefore they have referred him to such-in-such because of this. I have WellCare of Ga. and you have to be reffered to each and every doc you go to or they won't pay. Don't know if this helps but Good Luck to you.....

 Coventry/Healthcare Preferred PPO is one of those networks that has a lot of connections throughout the country because of their associations with other networks (like Beechstreet).  You probably have a lot more in network options than you realize because they are not listed in your local PPO provider listing.  

Omaha has one of the best DS surgeons in the country, Dr. Gary Anthone.  Kristi is the insurance specialist at the office.  I would be willing to bet that if you give her a call she will be able to tell you if they are a provider in your network. 

Happy hunting!  :-)

Thank you- I will call Monday. I appreciate the help!

 No problem - I will be interested to hear what you find out.