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Old 03-26-2009, 07:22 PM
BriellesMum BriellesMum is offline
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Join Date: Sep 2008
Posts: 12
Default HELP - Confused by Insurance! What is or isn't covered?? Frustrated

Well, now that Brielle is 9mths old old weighs 23lbs we've decided to go ahead and have the surgery and have Dr Waner perform it. Her H has grown (mostly outward) and there is little involution. We live in Delaware but feel Dr Waner is the best Dr to perform the surgery. We've scheduled her surgery for May 20th.

I've emailed Dr Waner's office (Sonja) and discussed insurance issues. They have been great but I still don't understand were we stand and what will or will not be covered.

I'm hoping someone can help me understand. Perhaps someone who has had same issues, same insurance, etc. Any help is appreciated!

Here are the details as I know them:

- We have Blue Cross Blue Shield Personal Choice Insurance (a PPO).

- In our plan Dr Waner is considered an out-of-network Doctor.

- Beth Israel Hospital is considered In-network

- Not sure if the ins will cover costs of Anesthiseologist.

- Sonja is waiting to hear back from Insurance Co to see if they will make an exception and accept Dr Waner as an In-network Doctor

Honestly, I am confused by all the info. I still don't understand how much we will have to pay out. How do we know if the insurance company will consider this an approved (and not elective) procedure? If this is an approved procedure and Dr Waner is considered out-of-network, how much will be covered (we are 80/20)

If the ins co denies it and we go ahead and pay for surgery, what are the odds the ins co will reimburse us if we appeal?

Any help would be greatly appreciated.
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