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  • How does one go out of network for a speciality Doctor?

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    Old 07-04-2017, 07:44 AM   #1
    jw622
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    How does one go out of network for a speciality Doctor?

    Feb 2017 I had a second nerve peroneal decompression (no foot drop) and a 4 compartment fasciotomy . April and May I was feeling somewhat pain free and felt the surgery was finally a success. June I started to wein off gabapentin and my pain came back. I went back up on gabapentin. NOW I can't get the pain under control. Every time I try to walk somewhat normal, bare weight, sit, well pretty much anything I do I'm back to constant pain. The ortho doc seems to think since the pain is more localized it's probably stuck in scar tissue. (B/c the pain use to radiate from the top of the fibula head to my foot!). Dr says move around as much as I can and is sending me to pain management for prolotherapy. Which ins does not cover. I follow up with my ortho dr in 2 months.

    I'm afraid the surgery didn't work. AGAIN!!!

    So now I'm wondering how do I go about finding a dr that has a more specialized skill in the peroneal by fibula or the common peroneal nerve? How does it work for insurance purposes? I looked up duke university and they take my insurance but online I'm not seeing a specialty doc for common peroneal nerve. I always thought duke was more specialty Drs... Online I see a specialty dr at Johns Hopkins. I don't see my insurance listed on their website. I don't know how it works. Anyone with experience going out of network? I haven't called my insurance yet. Just curious your dealings. (I have optima vantage which can be difficult at times).
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    Old 07-04-2017, 09:14 AM   #2
    MSNik
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    Re: How does one go out of network for a speciality Doctor?

    You would have to call your insurance company to check, but MOST insurance companies will pay 80% of the visit once you have met your deductible...therefore, if you have a 500$ or more deductible each year, you must reach that first.

    You would have to submit your bill, along with the insurance forms for reimbursement., The doctor you see will give you an itemized bill to do this. You will have to pay the doctor up front however, most people will resort to paying with a credit card and hope that the insurance reimbursement shows up before the bill comes due.

    It possible to see an out of network doctor, but its going to cost you. I personally go through this once a year to see my specialist who does not accept any insurance..the good news is one visit to him and my deductible is met for the year, so I always see him in January! After that anything I incur is always covered at 80% out of network, or 100% in network.

    I hope this helps...but call your insurance company to make sure!
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    Old 07-04-2017, 11:33 AM   #3
    jw622
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    Re: How does one go out of network for a speciality Doctor?

    Thank you Msnik!
    I will definitely call my insurance company and clearer details! Thanks for sharing your info!

     
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    Old 07-04-2017, 01:41 PM   #4
    MSNik
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    Re: How does one go out of network for a speciality Doctor?

    You're welcome!
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