Hi All,
I currently have a Kaiser Permanente Platinum POS plan.
I’m seeing a out-of-network surgeon in another state who specializes in reconstruction surgery. He is one of the few doctors in the nation who has experience in this type of reconstruction and there are no in-network doctors in my area who can perform the surgery needed.
My insurance specifically states that I can see any out-of-network provider via self-referral. I simply pay 25% coinsurance of the bill.
Despite having a POS insurance, my referral was denied due to “Service Available Internally and/or in-network”. This simply isn’t true because the type of reconstruction surgery I need is very specialized and he’s the closest doctor who can do it (the other one is in California on the other side of the country) and regardless of whether or not there was a doctor who could do my surgery, my POS plan allows me to pick and choose my doctor. That’s the whole point of having a POS plan.
I’ve been playing phone tag with Kaiser and none of them seems to understand I have a POS plan and seem to think I have an HMO plan.
Any advice from those who had similar problems?
submitted by /u/TeenageDarren
[link] [comments]
Hi All, I currently have a Kaiser Permanente Platinum POS plan. I’m seeing a out-of-network surgeon in another state who specializes in reconstruction surgery. He is one of the few doctors in the nation who has experience in this type of reconstruction and there are no in-network doctors in my area who can perform the surgery needed. My insurance specifically states that I can see any out-of-network provider via self-referral. I simply pay 25% coinsurance of the bill. Despite having a POS insurance, my referral was denied due to “Service Available Internally and/or in-network”. This simply isn’t true because the type of reconstruction surgery I need is very specialized and he’s the closest doctor who can do it (the other one is in California on the other side of the country) and regardless of whether or not there was a doctor who could do my surgery, my POS plan allows me to pick and choose my doctor. That’s the whole point of having a POS plan. I’ve been playing phone tag with Kaiser and none of them seems to understand I have a POS plan and seem to think I have an HMO plan. Any advice from those who had similar problems?
submitted by /u/TeenageDarren [link] [comments]Read Morer/HealthInsurance