Catch-22 advice needed

I didn't even know this message board existed until tonight....  :-) I was referred to Paul here about an insurance question. I am planning to have a bypass revision (BPD-DS) with Dr. Elariny in Vienna, VA. He is not on my insurance provider list. (No one on my provider list does this surgery.) His staff member in charge of insurance called me today and said she needed a referral from my doctor here in Va Beach before she could submit the insurance paperwork. My doctor's referral nurse said he could not refer me to a doctor out of network. Catch-22. I have left my doctor a voice mail message...but what do I do if this is true?

Uh...PPO, HMO...other type of insurance? Makes a difference. PPO usually has one reimbursement rate for in-network, one for out. HMOs usually need you to be on death's door in a foreign country and then they might think about making a decision to cover it before you die...

HMO (Optima Health)

You may be in a long fight to get it covered. I'd call the insurance company and find out what the criteria is for getting coverage out of network first.

Thank you, Paul. I can see where this process can drive someone crazy.  :-)  Dr. Elariny's insurance person called me back today to say they DON'T need a referral at this time....so I have printed out your reply to me for the future. I'm sure the next hoop to jump through will be forthcoming....Thanks again, Pat (She is submitting thr insurance papers today, so in a few weeks, I will know what to do next.)

You need to call you insurance company and see if there is wrap benefits, if you have no out of network benefit then it won't be covered.  I have seen HMO plans that have no wrap benefit and have seen some that have 50% coverage.