Question:
Has anyone had a problem with not having anyone within their network

I don't have anyone in my insurance network that does the surgery, so I am having to go out of the network. Has anyone been able to get their insurance to pay.    — Cindy S. (posted on August 24, 2001)

August 24, 2001
Hi. Yes, I went out of network and my insurance covered it. (The closest in-network Dr was over 6 hr drive away and backed up for months - closer out of network Dr was only 1 1/2 hours away and booked me three weeks out!) There are some important details that will probably help make a difference. Generally, if you have a PPO plan (not an HMO plan) you can go to ANY Dr you want and you will just be subject to usually higher deductible (mine was $500 out of network, $250 in network) and a higher out of pocket max for the year (mine was $2000 out of network, $1000 in network). Also, I don't know if you can't find a Dr in network doing WLS in general or are looking for a specific procedure (ie: BPD/DS) to be performed. I know that sometimes if there is no DR in network close to you, that the insurance can pay your surgeon as though he were in network (and hence your out of pocket costs would be as though he were in network) since their own network is not adequate enough to include Dr's in your area to perform the procedure they have approved. Hope this helps. Again, I am not familiar with HMO's so maybe another post-oper can answer you with help on those. Blessings,
   — ChristiMNB