Any one Insurance "savy" ?!?!?!? HELP!!!

Hi,
I finally found a dr. that would help me with all my Problems!!!! I have seen 4 OBGYN's in my area ( NY) and not one has been able to help me.( 9 yrs of frustration!) So I have contacted a specialist in PA, and he is wiling to help. Only thing is, I'm having a hard time getting my insurance to cover any apointments since he's in another state. Does anyone know what I can do?! Do I need a refferal from another Dr.? I have contacted my insurance co. and they said they can't do anything since he's not on their " list" of dr's. But shouldn't insurance cover you no matter where you have to get help, if the office excepts the type of insurance you have, what's the big deal?!?!?

Anyone have any ideas!?!?!? just my luck, I finally find a dr. who will help, and I can't get it!!!!!

thanks!!
Star

Have you been examined by the doc in Pennsylvania yet? Perhaps if you can show your insurance company the plan for treatment, they will reimburse your appointment.

I haven't been to see him yet, but I figured I could at least pay for a consultation apt. But I want to have all my " ducks in a row" with my insurance in case I need another surgery. I couldn't afford 40k in hospital bills!!!

I am in Colorado, and when I was a nervous pre-op, I sent an email inquiry to a doctor in PA. He called me on the phone and said that he could help me. It worried me that he was so confident over the phone, and I did not pursue any further info from him.

I hope you are able to find the right answers.

Do you have your insurance through an employer? If that is the case then your Office Manager can usually get more info and help from your insurance than you might be able to. Mostly because he/she has the right connections.

If you don't, then you can get better answers for special situations by first calling the insurance "customer service" and then asking to speak with a supervisor.

I have had good luck using both of those methods in the past.


Kay

Depending on the plan you have it's completely legit for them to say no to this new dr. Most insurance companies have HMO or PPO that restricts who you can/can't go to. There's a list of "in network" providers and if you go to a dr that's out of network, you can pay anywhere from a set copay or deductable to a predetermined percentage of the fee or even the full amount.
Call your insurance, find out what plan you have then talk to the dr's office and see what he suggests. Hope this helps!