HMO won’t cover out of network surgery, what are my options?

I have enlarged turbinates and some sinus issues causing constant head pressure and difficulty breathing. I have Blue Shield HMO. I saw two ENT specialists, I was really uncomfortable with both of them (outdated equipment and seemed dismissive of my symptoms, namely the pressure in my head).

After a lot of fighting, I got my health plan to approve an out of network second opinion. This doctor was fantastic, he found several issues the others overlooked and acknowledged my symptoms and found what was causing them. He recommend a procedure and the plan rejected it. I appealed but they said because he is out of network they cannot approve it, but they did approve it with an in-network doctor whom I’ve never met but has a bad reputation online.

I’ll have the option to change my plan to a PPO in January, but I feel like my symptoms are getting worse and I don’t want to wait. I also don’t trust the doctors in my town with this. What are my options at this point?

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I have enlarged turbinates and some sinus issues causing constant head pressure and difficulty breathing. I have Blue Shield HMO. I saw two ENT specialists, I was really uncomfortable with both of them (outdated equipment and seemed dismissive of my symptoms, namely the pressure in my head). After a lot of fighting, I got my health plan to approve an out of network second opinion. This doctor was fantastic, he found several issues the others overlooked and acknowledged my symptoms and found what was causing them. He recommend a procedure and the plan rejected it. I appealed but they said because he is out of network they cannot approve it, but they did approve it with an in-network doctor whom I’ve never met but has a bad reputation online. I’ll have the option to change my plan to a PPO in January, but I feel like my symptoms are getting worse and I don’t want to wait. I also don’t trust the doctors in my town with this. What are my options at this point?
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