Hi All,
I recently learned that my insurance can cover the medically necessary procedure of FFS. However, I am new to this whole insurance thing and have herd about in network and out of network coverage. How important is the surgeon that performs the FFS when it comes down to insurance and their network? It does sounds like it is possible to argue for an out of network surgeon, but how likely is this to go through? I'm wondering how reliable and experienced the in network doctors are vs out of network. I'm also worried the insurance company might try to get the cheapest surgeon they can find. Is this something to watch out for? Finally, is it better to do FFS all at once or do it in parts? Also, can anyone recommend any doctors in the Los Angeles Area? I am in the usa.
Ah the joys of insurance.
First off, what's this whole "in network" and "out of network" thing anyway?
In network providers are ones who have agreements to accept payment from your insurance company already. Out of network ones don't. This doesn't mean out of network providers can't accept your insurance, but it usually costs more for you.
With my insurance company I would have had to pay something like 20% of the cost of any surgery I had with an out of network provider. With something as expensive as these surgeries that ends up being pretty expensive! Your insurance policy is likely different and they may charge more or less, you need to check.
Some insurance companies will do an "out of network exception" or "gap exception" or some other term for the same thing. That is just a term for pretending that an out of network provider is in network due to not having anyone close to you. Since you live in LA, that might not be possible since there are lots of surgeons around but it's worth checking. I had SRS, FFS, and BA this way, but I live in a very rural area in the Midwest.
The good news is, in California you have many great options available to you fairly close by. Not all insurance companies get to tell you which doctor to see. (I think HMOs get to do that but I haven't had a policy like that.) For me I got to find a doctor I liked and they took care of hassling the insurance company for coverage.
I know Brownstein-Crane up in San Fran has some really great surgeons (Dr. Crane did my FFS, but he has his own branch office in Austin now), Deschamps-Braly is in SF as well and he does some really fantastic work.
Another thing to ask your insurance company is what sort of letters they require for this. Mine required a letter from my therapist for FFS but yours might require a second.
I have Kaiser insurance but im looking at the surgeons first and then will figure out how I will proceed. Kaiser does pay for the bone work on FFS but not soft tissue.
I have a consultation with Dr Kyle Keojampa today, he is in the LA area and I know he does accept insurance but not sure which ones
Thank you so much for the information. I was really well written. I still need to try and figure out which surgeons nearby are good to look into. This might take a while after all. I still need to talk to my doctor about it though he has given me a note already. I am hoping they also cover electrolysys since this one I would need quite a bit!
Has anybody had experience with Medicare paying for any surgeries?
Quote from: Russngrl on January 05, 2019, 09:59:07 PM
Has anybody had experience with Medicare paying for any surgeries?
From the reading I've done on the subject it sounds like they rarely do.