OUT OF NETWORK

I HAVE A PROBLEM ABOUT INSURANCE COVERING A DR OUT OF NETWORK. I WANT TO HAVE THE DS AND THE ONLY DR DOING THAT TYPE OF SURGERY IS OUT OF MY NETWORK. WHAT AM I TO DO. THERE IS A DR IN NETWORK THAT DOES ONLY THE RNY. HOW CAN I GET THE COVERAGE FOR THE SURGERY THAT I WANT. THIS SURGERY IS EXPENSIVE AND I HAVE GOOD INSURANCE BUT NOT FOR THIS TYPE OF SURGERY. WHAT IS THE INSURANCE BOARD

This happened to me about 5 years ago. I was nineteen and needed to have a lower spinal fushion. The local doctor told me there was nothing he could do for me. I wanted a second opinion and paid out of pocket to go see a doctor 2 hours away. He told me that I needed a fushion as soon as possible or I would eventually not be able to walk. Because I was only 19 years old this specialist at the Twin Cities spine center told me that he did not want to damage my back muscles so he instead wanted to do a experimental surgery where they enter from the front, and laproscopically insert a metal cage between the discs, pack it with bone and allow it to fuse over a eight month time span. When I went back to my insurance company they said NO! because they did not cover out of network stuff. But my doctor then sent then a letter stating that my local covered facilities did not do this type of surgery, and explained the benefits of his surgery over the ones the local facilites did. Once they figured out that my doctor was correct, and his facility was the only one in the nation at the time doing the surgery, they fully covered the charges. It was a huge battle, but it was kind of funny being able to tell my Mayo Insurance that I had to go somewhere else for surgery because the Mayo Clinic did not do it at the time. So try getting your doctor to write to your insurance company and explain the benefits of the surgery and that the other facility does not offer it.