Question:
Has anyone gone to a doctor that does not accept any networks?
I just got approved from Trustmark /PHCS insurance on 9/10/02. My surgeon's office called to tell me that they have decided to drop all networks and that by the time I have my surgery he will not be covering it. He is scheduling into November / December. She said that to continue I have to pay $4500.00 by 30 days prior to my surgery date. She said that out-of-network reimbursement is usually $1500.00 and they charge $6000.00 for an open RNY so I have to pay the difference up front. If the insurance ends up paying more I will get whatever money back. The hospital is still covered by my insurance so that part should be paid. Has anyone else had this happen to them? I am worried that if I stay with this doctor and something happens I will be left with HUGE medical bills. Any advice would be greatly appreciated !! — Kelly B. (posted on September 13, 2002)
September 13, 2002
Kelly, Dr. Fallang did the exact same thing to me. What I did was remove
myself from his service and I have two consults with other surgeons in
October. I have no respect for a man who has known since August 1st that he
would be leaving (that's when Connie said the policy in the office changed)
but they didn't tell me until I was approved (September 4th). Best of luck
to you, chica.
— LM O.
September 13, 2002
I purposely went to a Dr that was out of network only because I wanted to
have the surgeon of my choice not my insurances choice. I wasnt to happy
about the 6000.00 up front that I had to pay but I made sure I had it and I
paid it. You will have expenses, be prepared for that. Most insurances
only pay the surgeons 1500.00 bucks so most surgeons will drop the
insurance and have patients pay them. You will also be surprised that some
insurances will pay the surgeon more then the surgeon expected and you will
receive a refund, I received a refund of about half my down payment, I used
that to cover all my co pays and any other medical expense that wasnt
covered. In the long run hon its all worth it.....
— Deanna Wise
September 13, 2002
My doctor was also "out of network" but I knew that going in.
His was the third program I checked out and by far the best so it was worth
the extra expense. The insurance covered 70% out of network after the $200
deductible. The out of pocket was $2000 so basically all I paid was $2200.
Luckily there were no "over the usual and customary" charges.
— Lucky Gal U.
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