Question:
Please explain how I can get in-network bennies for out-network dr.?

I have UHC PPO/GE Preferred, my surgery has been approved, the hospital is 100% covered (its already in-network). However, I have been informed that they will pay out of network for my surgeon because he's not in network. I told UHC that there are NO bariatric surgeons in-network - none, zippo, nada. They said I should ask my dr. office to get innetwork benefits/pmt. Called the dr. office - she said they requested it in the LOMN and it wasn't her job to make sure that this is done - it is mine (ps I have a $5k refundable downpmt on this surgery). How do I go about this - I have spoken w/so many people at UHC I don't know where to go! My approval letter came from Missouri.    — Anne F. (posted on September 19, 2002)

September 19, 2002
which doc did you ask, your surgeon or your PCP??? Talk to both. Also, move up in the ladder at UHC. go to customer service and ask for the supervisor. Keep at it.
   — Vicki L.

September 19, 2002
Anne, Contact the benefits coordinator at the employers. When UHC was playing games with me, my husband called the coordinator and she called the insurance company, the surgeon and we had a four-way conference call. Things were straightened out before we got off the phone. Had to fight them to pay in-network for an asst. surgeon too. They will pay, just don't give up.
   — grammie5

September 19, 2002
Read through your policy. My plan specifically states that if there are no In Network Specialists w/in a 25 mile radius, then any Out of Network Specialist would be covered at the In Network level. Dependending on whether or not your plan is self funded, it may be more difficult to get the claims paid In Network. I would again, check w/the carrier, check w/the Doctor. See,even though they paid by surgeon at the In Network level, it's still less then he charged, luckily he accepted it as payment in full and didn't bill me for the discounted amount. Also, check w/UHC to see if you can nominate your surgeon as an a preferred provider.
   — Rosario T.

September 19, 2002
Anne, I agree with the other 2 posts. You cannot help it if there is not a Bariatric Surgeon in your location.I would also check and be sure the Anesthesiologist will be pd at in network rates. A supervisor or a company rep would be advisable to talk with. Good Luck Nancy Poe
   — NANCY P.

September 19, 2002
I had the same problem. Check with your insurance to see what you maximum out of pocket expense is. Most insurance companies have this cap by individual and by family. When you go over the out of pocket amount it is then covered 100%. For example my maximum for the year was $1400, therefore, I had to pay the 20% up to $1400 after that it was 100%.
   — Linda A.