Empire BCBS is trying to kill me

Last Monday I got the official approval from the my case manager at Empire BCBS and I was thrilled to death, my surgery got scheduled for April 5th. So today I open the long awaited official approval letter and find that, yes it does state I am approved but it is paying the doctor and the hospital at the out of network rate. My plan has absolutely no out of network coverage. So now I am having heart failure at what this all means. Does it mean they have secret second teir of payments to the doctors and hospital that no one knows about that is going to end up costing me thousands of dollars? Does it mean that if I can't come up with the money prior to my surgery they will cancel it.....And to make matters worse I read a post on the main message board this morning from a guy with the same insurance I have who had his surgery in October who now got a $4k bill from the doctor because he was supposably out of network. I looked the guys doctor up on the Empire website and he is in network. This is killing me, and of course its Saturday and I can't call and ask anyone anything. So here I am crying, when I should be getting ready for my new life to begin in 2 short weeks. This really sucks. Heidi

Heidi, I have BCBS through Texas and have in and out of network coverage but I'll share something that just happened to me last week...I was told that if there are no bariatric surgeons in my area that are participating providers that I could request in-network coverage from my surgeon. I submitted my request over the phone. It took about two weeks and finally got a call from an RN saying my request had been denied since there is a surgeon about 45 miles away that is a participating (in-network) provider. She said he's in my "area" within 1 mile. I didn't think I was going to change surgeons but went ahead and contacted that surgeons office. They said they are par-plan (in between "in-network" and "out-of-network") and not considered in-network. Soooo...I looked in my booklet and they were not listed. I called the RN back at BCBS and she checked into it and "sure enough" she was wrong. She immediately requested that my coverage be changed to in-network and it has been. Your insurance might have different levels of coverage. You might call them tomorrow and ask if your can request in-network coverage from your surgeon. You might also ask them if there is another surgeon in your area who is in-network. I know you don't want to start over but if there is a surgeon in-network you can afford the surgery. If not, they should give you in-network benefits (or so I'm told and from my experience with bcbstx). Take care and thank you for sharing your experience. Mary

I was just re-reading my post (I really should proof before I send). I want to be clear that my request for a referral for in-network coverage was handled between me and BCBS (my surgeon's office was not involved in this request). In other words, call your insurance and tell them you'd like a referral for in-network coverage. Mary