Help! Should I change my doctor before approval??

[SkinnyMiniMe 63]

Long story short. I had my consult almost finish with all my pre-op appointments. Come to find out my surgeon (who I love) does not take my insurance but will take their payment as payment. I will be responsible for my deductible. I called my insurance GHI last month and was told its $200, well the bill came in and now they are telling me its $300! My husband and I are both doing it so grand total will be $600.00. Then in January it will start all over again since its a new year! We are tentatively scheduled for surgery in December. I am thinking long term, $600 every year (until they raise the deductible again cause it never goes down) is a bit much when I can go to a surgeon that just takes GHI and all I have to pay is $20 per visit.

So my question is has anyone changed doctor's before being approved? Was it a messy situation? Or should I just fork it over to be less difficult? First year or two I will probably easily exceed that deductible but I am looking far ahead in a few years we will have to see him less. So $20 maybe once or twice a year is better than $300.00. I was told first year we have to go in once a month. Is that true? What about in 2 or 3 years? HELP!

[GoBanana 6]

Hey Skinny, do you have Emblem GHI?

[SkinnyMiniMe 63]

I think it is Emblem now...I know Dr. Holover takes it and that is the doctor I would switch to if I changed doctors ARRRRGHHH I got to make my mind up. I will have all my appointments done by 11/15.

Hey Skinny, do you have Emblem GHI?

[GoBanana 6]

well, i can tell you that Dr. Holovers office makes the approval process quick - they told me that approval can go through in as little as 2 weeks. so that leaves you some time to decide...i have Emblem Comprehealth but im switiching to GHI in January but the approval time is the same for Comprehealth anyway - so basically if you stick with your doctor you will have to pay 600 dollars every year?

[Phranp 46]

The first doc (the one referred by my PCP) was not on my insurance. He and his staff were fabulous, I was sorry to leave them. The second doc, who was on my insuraces website, turned out to not be on my inurance either. The third doc I went to I made sure he was on my insurance ... got all my tests done and had a surgery date. about 3 days before surgery I received a call telling me that my surgery was cancelled because the surgery center that my doc uses would not accept my insurance. I was mortified! Soooo upset. I called the surgery center, which was on my insurance website, and they told me that "yes" they had a contract with BCBS of CA, but that my insurance did not pay them enough so they would not allow me to have the surgery there. I called the benefits dept at my firm and they went ballistic ... it got a little ugly because the woman at the surgery center devulged info to me that she was not supposed to, but that's another story.

Knowing that my tests would not be valid for much longer I went on a Quest to find a doc. My insurance gave me a list of doctors and facilities. I found one, the doc understood about my insurance and the problem with facilities so he found a hospital for me and voila! instead of having my surgery on June 1, 2009, I had it on June 15, 2009.

It was a little stressful, but it turned out ok. With 2 kids in college at the time I couldn't afford to go with a surgeon that was not on my insurance.

Good luck to you! I know it will all work out.

~Fran

[SkinnyMiniMe 63]

The thing is I am only responsible for my deductible which is $300 per person a year. Since we already went to the consult I am already responsible for and it will cover the surgeries if they happen as planned in December. My husband and I already discussed it...and we think we will continue with him. Then in 2012 we will continue too because we figure we will go plenty of appointments that it will make sense. After we are done losing the weight and maintaining we will consider switching so it won't be so expensive. I guess being skinny is worth it.

The first doc (the one referred by my PCP) was not on my insurance. He and his staff were fabulous, I was sorry to leave them. The second doc, who was on my insuraces website, turned out to not be on my inurance either. The third doc I went to I made sure he was on my insurance ... got all my tests done and had a surgery date. about 3 days before surgery I received a call telling me that my surgery was cancelled because the surgery center that my doc uses would not accept my insurance. I was mortified! Soooo upset. I called the surgery center, which was on my insurance website, and they told me that "yes" they had a contract with BCBS of CA, but that my insurance did not pay them enough so they would not allow me to have the surgery there. I called the benefits dept at my firm and they went ballistic ... it got a little ugly because the woman at the surgery center devulged info to me that she was not supposed to, but that's another story.

Knowing that my tests would not be valid for much longer I went on a Quest to find a doc. My insurance gave me a list of doctors and facilities. I found one, the doc understood about my insurance and the problem with facilities so he found a hospital for me and voila! instead of having my surgery on June 1, 2009, I had it on June 15, 2009.

It was a little stressful, but it turned out ok. With 2 kids in college at the time I couldn't afford to go with a surgeon that was not on my insurance.

Good luck to you! I know it will all work out.

~Fran

[KBoo 3]

Here's the thing, between Doctor appointments, fills, blood work and any other regular doctor appointments I always make my $500 deductible, a lot of Surgeons advertise that they take insurance but they actually only take out of network benefits which means they can charge you anything they want and balance bill you what insurance doesn't pay, with that being said the fact the office is saying that they will take the insurance payment and your deductible as payment is great but get that in writing. Also if the doctor writes off the balance the insurance will see it as if you paid it so if you have to pay a percentage after your deductible is met the cost will most likely eat up all your maximum out of pocket expenses for the year. I would highly recommend having the surgery after the new year.I had mine in February and basically all of my doctors appointments/adjustments have been paid in full for the rest of the year because i hit my max out of pocket for the year.

This is the benefit of being married to an insurance specialist LOL

Good Luck!

[SkinnyMiniMe 63]

Well Thanks for the advice. Since I started the process already in October my deductible will be already covered if I have the surgery in December. Its too late to turn back now. I guess you are right I will probably meet that deductible anyway in 2012 again with all the fills. I have a feeling I am going to see alot more out network doctors from now on. At least take advantage. Thanks for the advice about getting it in writing. I have a friend that was sued 5 years after by a lawyer and the doctor was no longer in business so she could not verify with the office manager. She ended up being served to go to court and settled out of court. Don't want that to happen. I think I am more annoyed that I called my insurance last month and they told me it was $200 deductible per individual and now come to find out its $300 and since its for my husband and I it will be $600 but that will cover it for the rest of the familly.

Here's the thing, between Doctor appointments, fills, blood work and any other regular doctor appointments I always make my $500 deductible, a lot of Surgeons advertise that they take insurance but they actually only take out of network benefits which means they can charge you anything they want and balance bill you what insurance doesn't pay, with that being said the fact the office is saying that they will take the insurance payment and your deductible as payment is great but get that in writing. Also if the doctor writes off the balance the insurance will see it as if you paid it so if you have to pay a percentage after your deductible is met the cost will most likely eat up all your maximum out of pocket expenses for the year. I would highly recommend having the surgery after the new year.I had mine in February and basically all of my doctors appointments/adjustments have been paid in full for the rest of the year because i hit my max out of pocket for the year.

This is the benefit of being married to an insurance specialist LOL

Good Luck!

[SkinnyMiniMe 63]

Insurance companies drive me CrAzY!!! Well spoke to the office manager and she too was surprised about the deductible...I guess the teamsters union has a different plan Anyway so I went onto my insurance website and it says that out of network I am responsible for 20% Co-Insurance!!!! NO WAY will I be able to afford that!!!! The office manager told me to call on Monday, so if she still is willing to take whatever they pay as paid in full which apparently is 80% of the bill then I will stay with my surgeon if not then I will have to go to an in network. Which means I may have to push back my surgery (SIGH )