Question:
External Review says YES! Will insurance pay?

After 9 long months of psych evals, sleep tests, hundreds phone of calls, complaints to Insurance Commissioner, first and second level appeals and finally an External Review...I received a letter from External Review Board stating that the requested procedure (BPD/DS) is the "procedure of choice and the preferred procedure. Therefore the procedure requested should be approved". My insurance is an HMO...no in network surgeons at their hospitals...and they have fought me tooth and nail. Does this mean they will pay for the procedure and an out of network dr and hospital? Or will they pay only what they would pay an in network dr? While waiting all this time, I had even began looking into surgery in Spain. Will they pay the hospital and surgery fees there? It would be half of what it would cost in U.S. Anyone with similiar experiences?    — m S. (posted on January 8, 2002)

January 10, 2002
Congratulations on getting apprved on an external review - I believe that means that the insurance company is now obliged to pay your expenses. Could you let me know which insurance you are covered by? My insurance (Aetna) allows external reviews, and your case could be helpful to me. My email is [email protected]. Thanks!
   — K.C. B.