Plastic Surgeons

SI this is my dilema. I have already been approved for a pannectimy and lipectmy but I found out that the PS that submitted it is out of network. The out of network Out of pocket max is 3500. and then they only cover 60%. So I ask for a list of innetwork providers which is 8 pages long. I have called every one of them and noone actually works with insurance. The famous quote I keep getting is we don't bill to insurance becaus eit is consiered cosmetic. Well I have had it deemed medically necessary. I am willing to pay my portion. Has anyone had any luck with this.

 If they contract with your insurance company(which is why they are in network) they should work with you.  I suggest contacting your insurance company and explaining what you are running into. Ask to speak with a Case Manager. They should be able to help you sort it all out.

Wow, how frustrating - I hope you get it resolved soon. Which insurance do you have? I do read often people with Medicare have problems.

I have Blue Cross Blue shiel and I actually have the approval letter in hand.

Unfortunately, nothing can be done to make a PS accept your case.  The reason they are shy about it is the reason I was shy...the INS companies often delay, deny, or question the charge even if it was pre-approved.  This wastes time and may docs dont have a billing specialist to go after the money.

I dropped out of the networks because of this, and because I felt the contracts were unfair. When more and more doctors started doing this the companies responded by penalizing patients with higher out of network deductibles

You may find an out of net provider who is willing to TWIP (take what insurance pays) with a guarantee to not balance-bill you anything later in exchange for you paying a reduced fee up front.

Hope this helps

Thank you for you advice. I truelly understand the situation. It just gets frustrating becuase the cost of my insurance alone is expensive.

Thanks for the information, I actually resubmittd my paperwork to the insurance and instead of just the pannectomy I have a new approval for abdomonialplasty.   The other great news is as of today, because of anothr minor procedure, I have actually not only met my deductible for out of networ I have also met the out of pocket max of 3500. So my insurance will now pay 100% out of network. I'm gonna ask my 1st pick surgeon DR. L  about this on our next consult!!!!!!

Thats great news right there !  You are in the best possible position as you have already met that deductible.  Hope to see you soon

Thanks, I am exstatic!!!! I've been worrying poor elizabeth and shannon to death!!!!