Medicare Advantage and going out of network

[giro]

I (unfortunately) have a medicare advantage plan requiring the use of network doctors and facilities. My plan authorized me to obtain second opinion from a surgeon outside of my network. I would like to use him for my upcoming valve surgery. So my question is whether any of you, who are limited to networks, have been successful in obtaining out of network authorization. I am hoping that the insurance people at the hospital can accomplish this but I was wondering if any of you have succeeded in doing so and whether you have any advice. Thanks.

 

[dick0236]

Sorry no one has answered your question about out of network coverage. I've had a medicare advantage plan for several years but have always used "network providers" so I can't be of help to you. I'm surprised that the plan sent you to an "out of network surgeon" for a second opinion, so the plan may be willing to use the hospital where he practices. You've done the best thing in getting his hospital involved with your insurer. BTW, we are getting close to the "open enrollment " period and if you can put the surgery off until 2016 you can switch to a plan that includes his hospital.

 

[carolinemc]

Giro, you need to in touch with the insurance company to find out about out of network. Some will make you pay the full bill, others will pay part of the bill. Call them monday to find out. Good that you are not assuming anything without checking it out, but call the insurance company. Good luck and hugs for today.

 

[carolinemc]

Giro, you need to in touch with the insurance company to find out about out of network. Some will make you pay the full bill, others will pay part of the bill. Call them monday to find out. Good that you are not assuming anything without checking it out, but call the insurance company. Good luck and hugs for today.