Question:
how much would i have to pay for an out of network surgeon with cigna ppo

   — julie B. (posted on February 14, 2003)

February 14, 2003
You need to check your specific benefit info. I choose an out of network PS, but the hospital was IN network. Instead of the insurance paying 100%, they paid 80% of the doctor's bill, but the hospital bill was 100%. Each policy is different.
   — ZZ S.

February 14, 2003
I also had cigna ppo, I had to pay the deductable plue 30%. After the surgery I appealed the decision, because cigna PPO did not have a in-network docotr anywhere within a 100 mile radius, and they ended up paying the doctor at 90%, all office visits covered with only a 10.00 copay. My total to the docotr was $700.00. Hope this helps.
   — Valerie M.

February 14, 2003
Definately check your policy! Basically, if you go to a non-participating provider, they're going to want 100% of what they billed, they aren't contracted with the insurance carrier, so, they want their money. You need to carefully check your plan to see if they may pay. My plan paid for a non-par doctor at the particpating provider rate simply because there were no specialits w/in a 25 mile radius of my home and luckily my doctor accepted the payment amount as payment in fill. Read your plan, call the insurance company,do as much as you can...good luck!
   — Rosario T.

February 16, 2003
Julie, the previous posters have given you good information. The main thing is to be as candid as possible with your doctor. If Cigna does end up paying a higher percentage, then talk to your doctor about him accepting that as payment in full so that you won't have the bill. Doctors write-off debt all the time, especially if the doc is within plan. It could end up that what your ins. does pay may be more than what he would have received in plan anyway. The main thing is to be honest and candid. I don't expect any doctor to work for free...but they are more open if you're open and willing to work together. Good luck!
   — Diane S.