I have a disease that requires a surgery to fix. There are two types of surgeries that can be done. Option A has a 99% success rate. Option B has an 80% success rate. The success rate for Option B decreases with certain conditions (I have those conditions).
There are no “in-network” providers that can perform Option A. There are only two facilities in my state that will perform Option A (with one being ranked in the top two in the nation at performing Option A).
I filed for an “out of network exception”, but was not successful. Does anyone have any advise on how to get my insurance to cover the surgery? It should be noted that the “surgery code” for Option A would be covered if the facility was in network.
Age: 26
ZIP: 53713
Insurance: Quartz Prime
Disease: Pilonidal Disease (only look this up if you want to be grossed out)
Desired Facility: Evergreen Surgical (Eau Claire, WI)
Desired operation (Option A): Bascom Cleft Lift
Alternate operation (Option B): Excision
Thank you!
submitted by /u/if-I-had-A-hammer
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I have a disease that requires a surgery to fix. There are two types of surgeries that can be done. Option A has a 99% success rate. Option B has an 80% success rate. The success rate for Option B decreases with certain conditions (I have those conditions). There are no “in-network” providers that can perform Option A. There are only two facilities in my state that will perform Option A (with one being ranked in the top two in the nation at performing Option A). I filed for an “out of network exception”, but was not successful. Does anyone have any advise on how to get my insurance to cover the surgery? It should be noted that the “surgery code” for Option A would be covered if the facility was in network. Age: 26 ZIP: 53713 Insurance: Quartz Prime Disease: Pilonidal Disease (only look this up if you want to be grossed out) Desired Facility: Evergreen Surgical (Eau Claire, WI) Desired operation (Option A): Bascom Cleft Lift Alternate operation (Option B): Excision Thank you!
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