Question:
What if a doctor is not in my network?

I live in Ky and the closest doctor is at Louisville, none of the doctors are in my network. Does this mean that the doctors won't take my insurance or me? And will I be covered if the doctor does choise to see me? I have to drive about 6 hours and would like to know before I go.. Insurance is confussion... please email if you want to... thanks    — lyn K. (posted on March 28, 2001)

April 2, 2001
In my case, my group has no contract with a Bariatric Surgeon. I asked them if they would refer me out of network, simply because if the surgeon you want to go to accepts your insurance, and you PCP or Medical Group refers you, it is covered under your HMO. My insurance, "Pacificare," will only cover the surgery under the HMO portion. I am still waiting. If I self refer, i risk denial or paying $1500 deductible and 20% until I have met my $3500 cap on out of pocket expenses. I just cannot pull $3500 out of my wallet. Call your medical group and ask that they refer you out of their group. You have a right to do that. Allow 7-10 days for that referral, if they do not you can contact your insurance company, explain the fact that your group has no Bariatric Surgeons... in the realm of Quality of Service, you insurance company will/should help. Mine is. Best of luck.
   — Cheryl C.