Colon cancer patient with lung tumor. Oncologist set up an appointment with a thoracic surgeon at the hospital in which he was treated and operated on previously and all was covered as those doctors/surgeons took his coverage. Patient has an Oxford Freeom POS plan and everything previously was covered so the only payments he ever had were co-pays at the doctor’s office.
Thoracic surgeon’s office indicates he does not participate in Oxford. Was going to cancel the appointment and schedule something with another thoracic surgeon that is in the network but after searching Oxford’s web site, there are none in this state listed. What does a patient do at that point?
Years ago, my dad needed to see a specialist and had an HMO and since that HMO did not have the specialist he needed, they paid for him to see one out of network. Is that standard? I’m wondering what to do here. I could go forward and pay for the office visit but if surgery is required, I don’t want to see a bill for the difference in what the doctor charged insurance and what the insurance paid for the out of network service. The hospital at which the surgery would be done is where he had prior surgeries that were all covered so I assume that the only stuff that would be considered out of network would be anything this particular doctor does but all other services (hospital stay, nurses, etc.) will all be covered like last time?
This feels like quite a pickle. Appreciate any input.
submitted by /u/paget61
[link] [comments]Colon cancer patient with lung tumor. Oncologist set up an appointment with a thoracic surgeon at the hospital in which he was treated and operated on previously and all was covered as those doctors/surgeons took his coverage. Patient has an Oxford Freeom POS plan and everything previously was covered so the only payments he ever had were co-pays at the doctor’s office. Thoracic surgeon’s office indicates he does not participate in Oxford. Was going to cancel the appointment and schedule something with another thoracic surgeon that is in the network but after searching Oxford’s web site, there are none in this state listed. What does a patient do at that point? Years ago, my dad needed to see a specialist and had an HMO and since that HMO did not have the specialist he needed, they paid for him to see one out of network. Is that standard? I’m wondering what to do here. I could go forward and pay for the office visit but if surgery is required, I don’t want to see a bill for the difference in what the doctor charged insurance and what the insurance paid for the out of network service. The hospital at which the surgery would be done is where he had prior surgeries that were all covered so I assume that the only stuff that would be considered out of network would be anything this particular doctor does but all other services (hospital stay, nurses, etc.) will all be covered like last time? This feels like quite a pickle. Appreciate any input. submitted by /u/paget61 [link] [comments]Read Morer/HealthInsurance