Question:
What can you do to get a doctor that's out of your insurance network?

The doctor that I want isn't in the HMO network (Dr. Kane Jr.) and the one that is doesn't do laparoscopic surgery...I have heard good things about Dr. Printen; but he only does open surgery. Has any one had any luck getting Humana HMO to approve a surgeon that is out of the network?    — Pandora A. (posted on May 12, 2002)

May 12, 2002
Sad to say, but if your insurance has someone in networ who does any type of WLS, I would seriously doubt that it would be any easy task to get them to cover someone out of network. It would make no business sense to them. If you can afford to pay privately, then I guess that is not an issue. I had the RNY done open and I was only in the hospital less than two days and have had no complications. There are so many reasons I am sure that we would all prefer the lap, yet my doc really was adamant that he preferred to see what he was working on and the need to physically touch and measure the pouch and everything as we are all so different I guess. I wish you good luck!
   — Molly S.

May 12, 2002
Working in benefits, I can say that getting a referral approved for a doctor out of your HMO network is difficult. If there's a surgeon in the network and you were referred there, that's were you would need to go. To get approval for an out of network surgeon, your PCP would need to refer you to that surgeon and provide a VERY good medical reason why he's referring you to someone out of network when there's a perfectly competent surgeon in network. I won't say that it doesn't happen, but it generally takes an act of congress to make it happen! I wish you luck!
   — Rosario T.