Transition of Care APPROVED -- out of network neurosurgeon

[The_beat_goes_on]

I know a lot of people are changing and shopping around for insurance ... and dealing with new networks of providers.  The insurance I signed up for changed the network after I enrolled, but I was able to get my visits approved for 3 months through something called "continuity of care" or "transition of care" ... this is with Cigna, but if you are having the same issues (a recent surgery and a doctor newly out of network ....) it is worth checking out!  This is saving me about $200 an office visit AND any further procedure should be approved if it's within 3 months.

[selmaS]

  Hi and thank you for sharing that I am very happy u were able to get the INS u needed AND  able to get to see the Dr of ur choice!

And I am sure this will help someone in the same situation.

Please keep us posted on the outcome of ur next Dr visit.

[The_beat_goes_on]

Hi Selma ... just thought I'd update you guys on my insurance.  My Transition of Care ended 4/1 ... but I was able to get a network adequacy exception for my doctor, Dr Kim, pretty easily.  Again, I have a Cigna PPO plan from the marketplace.  Cigna pays 80% of in network charges to specialists (and NOTHING to out of network specialists!!!!).

All I had to do was call and make a network adequacy request.  The first line I got was, well, there are neurosurgeons in network in your area.  YES, there are, I agreed, but still got the exception after explaining that I have Chiari which is a brain herniation and there are only 2-3 neurosurgeons that specialize in Chiari in the Houston area (That I'd consider going to) and none were in network.  Hopefully this information can help someone else if they run into the same issue!

[selmaS]

  Well an issue there could be a NS could say they treat it and since they are a NS could  be considered a specialist....so a loophole we have to try and fight  as well.

Thanks again

[The_beat_goes_on]

I know!  Considering how hard it is for us to find Chiari specialists ... it was so important for me to keep this doctor.  I hope that anyone else having this issue gets to do the same.

I'm hoping all my issues are resolved within 3 months but I also don't want to rush into any other surgeries for my post-op issues because of this limitation ...  Every insurance plan HAS to cover an out of network doctor as in network if there is no other provider in network within your area.  I'm wondering if I could go in at the angle of there not being any other Chiari specialists in network (at least that I've found ...) ... if I have to try that I'll let people know if it works or not. :)

[selmaS]

  Great info thanks for sharing....I know there are many in this situation and do not know about this as a way to not only save $$ but continue to see the original Dr.