Question:
Has anyone had any luck?

I have United Health Care PPO adn my Doc is an out of network provider that my insurance usually covers 100% since there are no other doctor's that perform the surgery in Utah. But today I was told they have changed their policy and will only cover it at the 80% if I am approved. That is typical for me. My last chance is that my inurance company may consider a letter if I send it in requesting they cover my surgery since there are no other surgeons. Any suggestions?    — Darren H. (posted on February 20, 2003)

February 20, 2003
Most insurance companies put a little statement in the policy that says they can make changes to the benefits at any time. If the benefit now reads that an out of netwrork doc will be covered at 80%, that is the benefit, and you can appeal that but it probably won't be changed to accomodate you. Why not read the benefit for yourself and see if it is covered at 80%. Call customer service and ask to have the information faxed or mailed to you.
   — koogy

February 20, 2003
Although Susan is right about the insurance company being able to change the rules, I would definitely send in the letter. If they will approve the surgery, but don't have any surgeons in their network who perform it, then it only seems logical to me that they should pay the in-network rates. My surgeon was in network and so was the hospital, but the anesthesiologist, surgical assistant and the hospitalists were not. I called and asked my insurance company why I should have to pay out of network rates for those folks since I had no say in choosing them. They agreed and adjusted my claims accordingly. It is certainly worth a try.
   — garw