out of network after the fact

banded_for_life · September 7, 2005

Yes, they are affiliated with the SC of R. Their offices though are behind the sugery center around on the back side.

September 10, 2005

When I originally decided to do this in late July, I called Dr. Benavides office who referred me to AIGB to handle the preliminary diagnostics. So, I met with AIGB behind SCOR and left with a list of items that needed to be taken care of first such as Cardiovascular Evaluation and approval, psychological evaluation and then some fairly comprehensive blood work (beyond the normal CBC stuff). I have completed the first two items and will finish the bloodwork next week. All of the results have been sent to AIGB.

I have UHC and they know I have UHC but still advised that the surgery would be done at SCOR. If UHC doesn't have SCOR on the in-network list, shouldn't I be doing the surgery elsewhere? Does Dr. Benavides work out of any other facility that is in-network? Or do I need to start-over and find another physican, get my results from AIGB transferred elsewhere or what? Any recommendations, ideas, thoughts, suggestions would be helpful!

banded_for_life · September 10, 2005

The only hospital he works out that is in network is out of the metroplex, on the other side of Pilot Point. (for the life of me I can't think of the name of the town.) But the SCOR is aware that they are out of network for UHC and will do the surgery for the In-network price, whatever that price is for your coverage. Like for my UHC/MCI coverage, I am going to have to pay 500.00 out of pocket to the SCOR the day of my surgery. The anesthesiologist (sp) is also out of network and they ARE NOT willing to cut the same deal for the in Network price. They did say they are willing to make payment arrangments. I didn't ask all the right questions upfront and will end up paying more that I needed to. I had finished all my testing and had my approval, before I found all that out. I wasn't willing to start over again. I will just have to bite the bullet. I hope this helps.

Sheilaj · September 11, 2005

I don't know if this helps, but my surgery center was out of network. When I asked about the insurance payment on it, they told me they would accept the in-network allowance, and not penalize me for it. Maybe this is the same for you. Good luck! Cindy

Hi Mousecrazy, I'm using the same Dr. and surgical center that you used. I'm told the same thing about the center being out of network but they don't penalize the patient for the cost. I see you had your surgery on 7/22. I'm going for mine on 9/23 and want to make sure that the financial part is true. Have you had any trouble with this?

Thanks and Happy Losing!!

Sheilaj

Poodles · September 30, 2005

Regarding SCOR. They told me that AIGB is out of network, that the Dr. is out of network, that they would treat me like I was in network, but they never told me the Anesthesiologist (sp?) would not work the same deal.

How do you find a doctor that is considered in-network? Went thru my ins provider list and they do not specify.

Also called Dr. Hamns office and they told me that for other procedures they are in network, but for the band they are out of network.

I am confused. I have an out of pocket Max of $2000.00 but there is a difference of 20% between in network(20%) and out(40%). Can someone explain it to me? If I have an out of pocket max, does it matter what the anesthesiologist charges?

I have TRS activecare. Has anyone used it?

And BTW, I have an appointment with AIGB on OCT 10th so I need to know something quick!!!!!!