I have insurance through work in DC, where they're legally required to cover all things trans-related. I am planning to call on Monday and confirm that they'll cover the procedures I'm considering, but I am curious how things work if there are no doctors in network that perform a particular procedure.
Would they just have me pay the out of pocket limit and go to the doctor of my choice? If they do come up with a participating provider, am I obligated to go to them if I want any coverage?
I've never had to mess with insurance before. I'd be completely happy paying my out of pocket $6k as long as I can choose my surgeon. But this is my junk so I can't get down with letting any old doctor do it.
I have CareFirst BCBS, if anyone has specific experience. General advice is also happily accepted :)
I don't know specifics for the company you have, but where I live you have to deal with the provider they are contracted with, but my out of pocket costs are the same as they are for any other provider I go to that they are in network for. I hope that helps some. Hugs
Mariah
I'm in the middle of getting approval for my hysto and found out that in my city, which is a really big city, my insurance has exactly one contracted physician to do the dirty deed. My case manager is trying to find out if I can get my preferred doctor covered instead. The answer might ultimately be "no," but I'll have to wait and see.
Since I have already met my deductible, I will pay a $1500 copay even if I go with their surgeon, but I will obviously pay more if I go with my own surgeon and they decide he isn't fully covered. However, the amount I pay depends to a certain extent on what I've already paid out on other services this year. The copay for this surgeon is normally $3000, but that amount is offset by my payments all this year. So he might run $2500 or even less.
It really depends on the specifics of the plan, so you are best off if you gather all of your information and questions and then call your insurance company.