Question:
Any in-network Dr's in Chicago IL? What will be my part after ins?
I am looking for an in-network surgeon in the Chicago area because my ins will pay 100%, but if I go out-of-network my portion would be 20% of reasonable & customary + deductible. What I need to know is what would be my portion after ins. (ballpark), and is that for the surgeon only or the hosptial too. Is follow-up covered? I would prefer to go to an in-network DR vs. out but am having trouble locating one as well. Please HELP :) — vllgmz4 (posted on June 18, 2003)
June 18, 2003
In-network for what insurance plan? Is it a PPO, POS, or an HMO? If you go
out of network on a PPO or POS, you do have to pay a portion of the bill,
but many insurance plans cap your share. Your insurance plan should be
able to tell you what your "maximum out of pocket" cost is.
Usually, the maximum out of pocket cost is described as your deductible
plus some flat amount (for example, a $250 deductible plus $2500 for a
maximum of $2750). This is an annual amount, so just about all of your
expenses (surgical, hospital, doctor, follow up) fall under it. These can
be different under different group plans, so call your insurance company or
your employer's benefit people to find out how this works in your plan. If
you're covered under an HMO, then you would not have any coverage out of
network. Check this site for information on how to find a surgeon. You
can probably find out which insurance plans any given surgeon works with.
And, best wishes along your journey.
— Vespa R.
June 18, 2003
Ok here's Humana's Web site www.humana.com, in the left column click FIND:
A Doctor or Hospital, next type in city or zip, (State/Territory) type in
Il for Illinois click continue. Next is the Select Your Plan page,
highlight Humana PPO click continue, next pg click continue again. Next is
the Select a Provider Type page, where it says Type of Provider arrow down
highlight specialists click next. Ok now we're cooking, next is Select A
Specialty and Search Method, under the word specialty highlight Surgery
Thoracic, next put a dot in the IPA Affiliations (these are clinics in the
Chicago area) highlight the clinic you want click next and WALA you have
your PPO in-network provider dinner, LOL LOL. Good Luck
— Barbara M.
June 19, 2003
Ok, go to "Find a Doc" option at the top of the page, then to the
referral link, then to IL. That will take you to the list of doctors in IL.
The list shows the doctors and the town their office is in. There are many
there to choose from. When you click on the doctor's name it will bring you
to data about that doctor and included in that data is the insurances that
that doctor has accepted. I went with the WISH Center out of Downers Grove
and my husband is going with the Kane Group out of Elk Grove Village.
Unfortunately, the WISH center is out of network for most insurances, but I
am glad that I was turned down by a network doctor because I think the
program at the WISH center runs rings around other bariatric doctors. If
you would like more info on my experience with the WISH center just email
me and I will be glad to touch base with you.
— ChristineB
June 20, 2003
OOps, I made a mistake, I should have been more specific about the charges
in question. I pretty much understand what my ins will require me to pay,
but what I'm wondering is if the Dr. or center will have me pay anything
that was NOT covered by ins (more than reasonable & customary)and about
how much that will be.
— vllgmz4
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