Insurance & "Out of Network" Top Surgery

[Sam Alexei]

Hey there! The surgeon I'm looking at for top surgery, Dr. Thomas Satterwhite of Brownstein and Crane, is in network for my general insurance of Anthem Blue Cross. They are, however, considered out of network for my specific insurance group WITHIN Anthem, and the approval is currently still pending. Fingers crossed that it goes well!

My question is: for those in the United States who had trouble getting a specific surgeon covered by insurance, did you find a way around it, and if so, how? Did you just end up paying out of pocket?

[Jessirules]

I am currently investigating getting FFS surgery covered by insurance it looks like it's going to be quite the battle I'll let you know how it turns out

Jessi

[Sam Alexei]

Update:

They denied my request, but offered me an in-network surgeon who seems to know his stuff, so I'm taking it!

[RaptorChops]

I was not aware of how any of the insurance thing worked because I was a fool to assume things. My insurance is supposed to cover 100% in network and 60-70% out of network. I called the insurance company and asked them what the steps were for a surgeon out of network and I was told to pay out of pocket and then file a claim. I had my surgery 6 months ago and my surgeon has sent my insurance company my paper work several times now. The insurance company continues to send me letters saying they never received any of it. So on top of the 8k I paid out of pocket I did not get compensated at all for my time off from work. So  I missed 6 weeks of pay too. I'm just lucky I had money saved.

My best friend has been having problems to try and get covered for his surgery. He decided to go with Dr.Rumer and he has been back and forth between Rumer and his insurance. Rumer's office told him that they took his insurance and all that and they just needed to follow up with the insurance company. He had his consult in August and Rumer's office called him back and said they did not take his insurance. So he's at a loss because he can't pay out of pocket.