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a2twinsnanny

Surgeon is out of network

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a2twinsnanny
, 07-03-2014 at 09:55 PM (1435 Views)
Well I received a letter today from my insurance, United Health Care. I don't know what is going on but apparently my surgeon and my primary care physician are both going to be out of network with my insurance starting 7/31. I was supposed to have my surgery this month but now I am considering finding another surgeon that is not renewing their contract or agreements with my insurance.
I am still waiting on my approval letter so that means I can't get my surgery on the calendar despite I had a tentative date early July.

Is this really happening!?! So I know that I do not have control over getting the claim filed and approved any quicker. I was hoping that my paperwork would have been sent from the pcp to the surgeon within a few days from my final 6 month supervised diet. Of course the I called exactly a week after my appointment and the paperwork had not been sent so I called 3 days in a roll to get that taken care of ( squeaky wheel gets the oil)
Then I called the nurse case manager through my insurance and she will be on vacation until the monday after july 4th I guess for a early holiday. So now once she returns to work and receives the claim I wonder what is the next step... and how much longer will it take for the approval or denial letter to come. I know they have 15 days to respond but I wish it would take less time so that I can get my surgery before my surgeon becomes out of network.

I wonder if the other surgeons within my Weight Loss Clinic group are also going to be out of network.

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Comments

  1. Fae's Avatar
    So sorry. If it ain't one thing.....I hope everything works out for you.
  2. Nick Nic's Avatar
    See I have the same ins and once your Nurse Case Manager gets it they normally don't take that long to approve. Mine took less than a week. You are doing the right thing stay on them. I know everyone was tired of me calling and getting on them but oh well. It was my case and no one is going to fight for you. Hang in there.
  3. AHLButterfly's Avatar
    I have UHC and I was approved in less than 24 hours. I was actually approved the same day. They submitted info that morning and I was approved by lunch time. I couldn't believe it. Also, UHC was willing to work with me on allowing me to use an out-of-network doctor since I lived more than... I think 50 miles from an in-network surgeon? I'm not sure if that is the case in your situation, but they were very lenient with me.

    I bet you will be approved before you know it Good luck!
  4. Rocksjourney13's Avatar
    So sorry for this news. It is so hard getting through the red tape once you have gone through the entire program. I have been going through this for over a year now and am still not sleeved. I wish you greater success than I have had. Good luck, many blessings for a safe surgery.
  5. tweetykermit's Avatar
    I also had UHC and once the information was sent to them from my doctor after my six months it was really quick about a week for getting the approval. I was really lucky that I found a doctor that was in network at a center of excellence which with my program meant getting money into my MRA account after having the surgery. What I would do is to make sure to look at your particular insurance program. I wish you the best it has been slow going weight lose for me but I am not gaining and I need to really get into the exercise which I truly believe will help.