Insurance hurts my head

[Charlie524 0]

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!

[RestlessMonkey 7]

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)

[Charlie524 0]

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

[Charlie524 0]

Oh and my annual cap is $7500, after I spend that much they cover 100%.

[RestlessMonkey 7]

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.

[Charlie524 0]

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.