Out of coverage Doctor

Sorry about the 1st post ...I have found a Doctor in New Jersey who i would like to do my Lap Rny . The problem i have is that I live in Pa. He is not a member of the Keystone Health Plan East participating doctors. I am willing to pay some of the fee out of coverage but can't pay the whole amount. I can get the procedure fairly quickly with the NJ Doctor. He has come to me highly recommended. I have met with him in a seminar and i am impressed with him. I have tried 3 Doctor's in my coverage plan . None of these doctors can see me for at least 9 months. I have finally got the courage to do this and now i am looking at probably a year. Do I have any recourse ? I don't think i can wait for a year. Can I appeal this to my insurance? Thanks in advance. Sue Thacker

Review your insurance plan's requirements to make sure they will cover it AT ALL. Most require 6 to 12 month's of pre-care to pay for anything. (Registered dietician, psychiatric evaluation, sleep apnea study, cardiac work up) If it will pay for the out of area doctor and you want to go sooner- your uncovered medical expenses are tax deductible and the NJ doc has a payment plan, I'm sure. I think your plan will be able to argue that the services you need are provided in the network and if the wait isn't life threatening they may not consider out of network payment. I know 9 months seems like the wait from hell. It is unfortunately pretty average. One program in Boston is backed up 3 YEARS and is no longer taking new patients. I'm looking at about 14 months between initial contact and surgery. I would roll myself into the OR tomorrow if I could but I am in a good program with well developed pre and post care. It has a 30 year track record and is worth the wait. I've been to support group meetings- we are required to attend pre-op- these internet sites do not fill the need for one on one contact- even this one. I have sat down with people who are dealing with depression, divorce, vomiting, pneumonia, friends who are uncomfortable with the 'new' friend and no longer return their calls. I can understand your need to act on your decision ASAP. However, I have learned so much during my wait, my expectations are more realistic and I know how to take care of myself mentally and physically. (They only operate on our guts- not our heads) I would encourage you to put yourself on a local physician's appointment schedule even if it is 9 months in advance. The appointment can always be cancelled if you get in the NJ program and it will save you making it 4 months from now if you can't work out NJ. Please consider a closer, in network plan. Mine will be seeing me monthly for about 2 years post op and I will be welcome at suport groups forever. They will also be just down the road if there are any complications. Let us know how this goes, OK? Christie