Question:
Anyone have an assistant surgeon that was not a preferred doc with insurance?

My WLS doctor is a "preferred" provider w/Aetna, but the assisting surgeon is not. Will Aetna pay for him? In the past, I have had to pay a small precentage for "out of network" providers. If I am approved 100% for everything (surgery, testing, hospital stay), will I still have to pay our of pocket for the assisting surgeon? THANKS!!    — toolio (posted on February 11, 2003)

February 11, 2003
The previous poster is correct - check your plan! My PPO plan was different - because there was no gastric bypass specialist within a 25 mile radius of my home, the surgeon, hospital and anesthesiologist were paid at the PPO level and luckily they accepted it as payment in full (since they weren't contracted, they were under no obligation to do so). My plan paid for the assistant surgeon at the non-contracted rate, and actually they reduced what they paid him by alot because he actually charged more than the surgeon - luckily we worked it out! Worse case, AETNA will pay for the assistant surgeon at the non-PPO level and your out of pocket will be higher.
   — Rosario T.

February 11, 2003
Hi, I had the same thing. The assistant surgeon, anasthesiologist and the hospitalists were all out of network. My brother called when he saw the EOBs from BC/BS and said that since I didn't have any choice in those docs, I shouldn't have to pay out of network rates. They agreed and those docs were paid at in-network rates. I spent a LOT of days in the hospital after my surgery, so the hospitalists' charges were pretty high. One of that group saw me every day that I was hospitalized. It is most certainly worth a call to your insurance company's customer service dept to find out.
   — garw