Hey All! I have never had anything major medical come up until this year when a tumor was found in my breast. Luckily the tumor was determined to be benign, but it was recommended that I see a breast surgeon to get it removed. I was referred to a local in network hospital and met with one of the three surgeons there for a consultation today. Afterward, I reached out to my insurance company (Anthem CA BCBS PPO) to verify that the surgeon doing the work is also in network.
I was informed by two different customer service representatives that although the hospital is, the surgeon was not in network and that they could not find any in network breast surgeons within a 50 miles radius. (I am located in NJ). They pretty much told me they didn’t know what to tell me. I do have out of network benefits but do not want to use them because all off the imaging and biopsy I have done will all come close to meeting my out of pocket max.
What should I do in this situation? Do I reach out to the hospital to see how they bill? Do I ask and see if the surgeon’s billing office will accept a single case agreement of some kind? Is there someone else I should reach out to at the insurance company? Has anyone elected dealt with this before? I have never encountered a situation where there were no providers like this. Thank you so much in advance for your help!
submitted by /u/NMK66687
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Hey All! I have never had anything major medical come up until this year when a tumor was found in my breast. Luckily the tumor was determined to be benign, but it was recommended that I see a breast surgeon to get it removed. I was referred to a local in network hospital and met with one of the three surgeons there for a consultation today. Afterward, I reached out to my insurance company (Anthem CA BCBS PPO) to verify that the surgeon doing the work is also in network. I was informed by two different customer service representatives that although the hospital is, the surgeon was not in network and that they could not find any in network breast surgeons within a 50 miles radius. (I am located in NJ). They pretty much told me they didn’t know what to tell me. I do have out of network benefits but do not want to use them because all off the imaging and biopsy I have done will all come close to meeting my out of pocket max. What should I do in this situation? Do I reach out to the hospital to see how they bill? Do I ask and see if the surgeon’s billing office will accept a single case agreement of some kind? Is there someone else I should reach out to at the insurance company? Has anyone elected dealt with this before? I have never encountered a situation where there were no providers like this. Thank you so much in advance for your help!
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