Charlie524 0 Posted March 17, 2009 So I have Anthem of CA which covers surgery as long as it is approved and my dr. is a provider at 70% after I pay my $2500 deductible. The dr. I have met with so far and really like isn't a provider, but will be within 6-8 weeks. I really wanted to get surgery prior due to my job being right in the summer. I wanted to have time to recover before and give myself a lot of time to heal. So here are my options...wait until they become a provider and use my insurance (still pay about $6k out of pocket with deductible and remaining 30%) Use them as an out of network provider and my insurance will pay 50% of the amount allowed but i have no idea what that is. Pay the dr. out of pocket $4k and bill my insurance just for the surgery which will end up costing me out of pocket about $9k. Would you wait the extra few months to save $4k. I am not rich by any means so that is a lot for me, but having the healing time is really important as well. I am so confused! Share this post Link to post Share on other sites
RestlessMonkey 7 Posted March 18, 2009 I'd go find a provider who was IN NETWORK now and get it done. And they cover at 70% after your deductible, but what is the annual cap? (Most companies have one) Share this post Link to post Share on other sites
Charlie524 0 Posted March 18, 2009 (edited) I think I have decided to wait until this dr is in the network, it should be 6-8 weeks. I am in the wedding business and our busy season is really only starting in June. I think if I can get this done within May I should be fine. I know there are a lot of great surgeons out there, but I really like this dr and his entire staff so would like to use them, Edited March 18, 2009 by Charlie524 Share this post Link to post Share on other sites
Charlie524 0 Posted March 18, 2009 Oh and my annual cap is $7500, after I spend that much they cover 100%. Share this post Link to post Share on other sites
RestlessMonkey 7 Posted March 18, 2009 I think your plan is good, as long as he does become "in network" in 6-8 weeks. Why the wait? What if there's a glitch? Only you will know the right decision. If it were me, I'd either make sure from the insurance co. that he's "in line" to become in network, and get a timeline, or I'd go somewhere else. He's probably really good but also probably not the only really good one around. I'd wonder about the "6=8 week" thing, especially since you are on a deadline. Share this post Link to post Share on other sites
Charlie524 0 Posted March 18, 2009 Hi Restless, I know, I was thinking about this as well. May 18th-June 21st is my only other open window. We have a job on May 9th, May 16th and June 28th so if it is not done within that week of May 18th I would have to wait until October! When I first started seeing them they were supposed to be in the network within 3-5 weeks so it does bother me a little but I have already grown attached. I am going to attend another dr's seminar on march 23rd so we will see. Share this post Link to post Share on other sites