Question:
my company just changed me from Anthem to Oxford, with a exclusion clause...help!!!

i am a week awy from pre-op meeting and lb work, ect with a tenta tive surgery date in Feb and all of a sudden I was informed that my company is dropping Anthem and going to oxford with an exclusion clause...what do I do now?? Very Disenchanted!!!    — dreaspace (posted on January 20, 2006)

January 20, 2006
Hi Andrea Very important question is: were you already authorized by the old insurance carrier? If so, the new carrier has to honor their decision. i know, mine went from blue cross HMO to PacifiCare HMO after i had been authorized- and it was honored. It would have been honored even if it hadnt been authorized first,, because my medical group whom I worked for, always made sure when we changed, we changed with the same plans except for maybe a small difference in the co-pay. If you had alrerady been authorized, make sure this new insurance carrier has all of the info from the old one- and that the person in your HR office takes care of the glitch. I wish you great luck on your surgery- do not give up- this is just one bump in the road. If you need any more help give me a holler, I am pretty good at making insurance companies sit up and take notice- they hate pushy doctors :) Cindi -217#
   — DollyDoodles

January 20, 2006
Hi Andrea Very important question is: were you already authorized by the old insurance carrier? If so, the new carrier has to honor their decision. i know, mine went from blue cross HMO to PacifiCare HMO after i had been authorized- and it was honored. It would have been honored even if it hadnt been authorized first,, because my medical group whom I worked for, always made sure when we changed, we changed with the same plans except for maybe a small difference in the co-pay. If you had alrerady been authorized, make sure this new insurance carrier has all of the info from the old one- and that the person in your HR office takes care of the glitch. I wish you great luck on your surgery- do not give up- this is just one bump in the road. If you need any more help give me a holler, I am pretty good at making insurance companies sit up and take notice- they hate pushy doctors :) Cindi -217#
   — DollyDoodles

January 20, 2006
Andrea, What about COBRA? Can you opt to pay the premuim (plus 7% or something) to Anthem directly? You are SOOO CLOSE!!!
   — cheide

January 20, 2006
Hello Andrea, The first thing to do is take a deep breathe and let's think things through. First thing is first, as previously stated if your surgery has already been approved by Anthem then you do not have anything to worry about because Anthem will have to honor the authorization. Secondly, when does the change over from Anthem to Oxford take effect? It is already late January so I highly doubt that it is Feb 1st, which means that it will more than likely be March 1st at the earliest. The only concern I have at this point is your follow-up appointments. It is very well possible that you current surgeon may not be a part of Oxfords network which would cause you to either one follow-up with a general surgeon that is in their network or two pay out of pocket if you want to continue with your existing surgeon. I would first find out if your surgeon has already gained authorization for the surgery and secondly I would not mention the insurance switch to him/her just yet until after you know something for sure. I hope this helps ... Tiffany
   — Tiff's On a Mission

January 20, 2006
I agree with Tiffany about the insurance changing issue. If it doesn't change until March your fine. When insurance is billed for the surgery part of the bill is your immediate follow up care, normally for 3 months, so initially you wouldn't have any co-pays and then after that period of time when there are no complications then you would need to decide if they will cover your regular appointments or if you would need to pay out of pocket. My surgeon only charges 50.00 for follow up appointments so it's not normally that bad. Good luck with your journey.
   — dlryanoates