insurance question

I have a self funded insuance through my work and they do pay for WLS. I want to have a revision from an RNY to a DS. The problem is there are no physicians within my immediate network who do the DS but if I go to my national netwok Dr Schweitzer at Johns Hopkins is on it as a provider. The problem is if he or any physician within my immediate network does the procedure then it cost me $200 out of pocket. If i have to go out to the extended network which he is on...... then it becomes an 80/20 split. Since no physician is available within immediate network do I get to be charged the immdiate network price for a national network doctor?

This needs to be addressed to your insurance company, for all plans and especially self insured plans all play by different rules.
When you call, get a reference number that documents your conversation.
good luck...Joan

This is well worth looking into and fighting for.  I am pursuing a DS and I know my insurance states that if you don't have the specialist you need within a certain number of miles of you, they will pay at the in-network rate instead of the out-of-network rate. 

Call, search online, find the answer you need and document it.

nancy