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Any advice on making sure insurance will cover all? anesthesiologist, etc.?

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Posted 10/27/2009 7:02 PM (GMT -5)
 

One person commented to me at work that they made a mistake with their dad's prostate surgery where the anesthesiologist was considered Out-of-Network, and they didn't know before the surgery.

Do you start these questions with the doctor, or the insurance company? Any advice to make sure we get it right?

Posted 10/27/2009 7:29 PM (GMT -5)
denver,

i can only speak from my own experience with what you are asking. all my doctors, hospitals, specialists, test centers cleared with my health insurance carrier on their own. i didnt have any problems or have any limitations with my choices. if you have the slightest doubt, then by all means, call and talk to your insurance company by phone, and be sure to get the exact name of the person(s) you are speaking with. good luck.

david in sc
Posted 10/27/2009 8:03 PM (GMT -5)
In most cases if you pick an in-network hospital, all the services including dr's that the hospital provides are covered

You would never be able to get the names of every Dr that sees you in a hospital before hand to get them pre-approved

You can try to call the Hospital and ask them who the anesthesiologist will be for your upcoming surgery, but I doubt they will know
Posted 10/27/2009 8:34 PM (GMT -5)
I was just warned about this very issue by my insurance company (BC & BS). They cautioned me to check to ensure that the anatheseologist was preferred otherwise they would not pay all of his fee. They also said that the DR and NOT his practice had to be preferred. I checked with the hospital and they gave me the name of the company with which they contract for these services and they confirmed that all their DRs were preferred under BC & BS. I can tell you from experience that even though a hospital may be participating under a specific policy that does not mean that all the labs and Drs they use are. It is a real hassle to determine but you are safer to take the time to check.
Posted 10/28/2009 7:10 AM (GMT -5)
Mr. Gimpy is correct about the hospital being in-network. I had a similar situation with a D&C I needed a few years ago. The hospital and my OB/GYN were in network but the anesthesiolgy group was not. I called my insurance company right away and told me not to worry - I was covered. As long as the procedure was done by an in network doctor and hospital, all services provided would be covered. To be safe, double check with your insurance company.

Good luck with your surgery ... we'll be waiting for you right here.
Posted 10/28/2009 7:15 AM (GMT -5)
Out-of-Network DOCS are covered but at a much worse rate.  Depending on where you live and other factors - Out-of-Network is all there is so most insurance companys cut you a lot of slack. If you live in a big City like I do, you should be able to find an In Network...
Posted 10/28/2009 6:43 PM (GMT -5)
You should confirm that your doctor and the hospital are in-network with your plan. If you do that, the covered charges for all other providers, even if they are out of network, will be paid at the in-network rate. This is a common practice in the industry. Having said that, the claims shop may still screw this up because most claims are auto adjudicated i.e processed by a computer. If they pay at the out of network rate, they should correct the error when you bring it to their attention.
Posted 10/28/2009 7:02 PM (GMT -5)
Denver Survivor,
What everyone has posted is good advice. Purg is right to get names, dates etc. When I had my surgery the DR and his staff was in the network but not the hospital. My surgery was done at another hospital. These folks apparently had been down this road before. The Dr came to the in network hospital with his nurses to perform the surgery. Everything was covered in network this way.

Jon
Posted 10/28/2009 7:24 PM (GMT -5)
I had a non covered doctor but they were all over it, and very clear on the charges. I really think it is up to the hospital to work out the insurance stuff. If the used a out of program guy without your notice I would not pay the bill.
Posted 10/28/2009 9:10 PM (GMT -5)
I was going to say what engineer said. They'll send you you nasty letters, threaten collection, etc., but in the end for the difference in network vs non network, they'll usually write it off.

What the heck, we are cancer survivors. No darn bill collector is going to intimidate us !
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