Comments on: Yet Another Out Of Network Charge http://www.healthinsurancecolorado.net/blog1/2009/04/10/yet-another-out-of-network-charge/ Research and discussion of the Colorado health insurance industry and the healthcare crisis in America. Thu, 19 Nov 2009 21:34:25 -0700 http://wordpress.org/?v=abc hourly 1 By: Jay http://www.healthinsurancecolorado.net/blog1/2009/04/10/yet-another-out-of-network-charge/comment-page-1/#comment-13178 Jay Wed, 01 Jul 2009 17:48:17 +0000 http://www.healthinsurancecolorado.net/blog1/?p=1097#comment-13178 Our appeal was approved! Thanks to everybody for the good advice. Our appeal was approved! Thanks to everybody for the good advice.

]]> By: Artromick http://www.healthinsurancecolorado.net/blog1/2009/04/10/yet-another-out-of-network-charge/comment-page-1/#comment-13177 Artromick Wed, 01 Jul 2009 14:02:14 +0000 http://www.healthinsurancecolorado.net/blog1/?p=1097#comment-13177 Its really curious to see how easy its to get health insurance but how difficult to claim it. Cannot the assistant doctor's cost be included within the Surgeon's total cost? Anyways I hope things get sorted out for you. Its really curious to see how easy its to get health insurance but how difficult to claim it. Cannot the assistant doctor’s cost be included within the Surgeon’s total cost? Anyways I hope things get sorted out for you.

]]> By: Louise http://www.healthinsurancecolorado.net/blog1/2009/04/10/yet-another-out-of-network-charge/comment-page-1/#comment-13109 Louise Thu, 16 Apr 2009 02:29:00 +0000 http://www.healthinsurancecolorado.net/blog1/?p=1097#comment-13109 Kevin, Thanks for this! It's interesting to note that consumers are often advised to make sure that all of their providers are in-network, rather than just the primary doc and/or facility. I'm curious now to find out more about this rule. I appreciate the heads up! Kevin,
Thanks for this! It’s interesting to note that consumers are often advised to make sure that all of their providers are in-network, rather than just the primary doc and/or facility. I’m curious now to find out more about this rule. I appreciate the heads up!

]]> By: Kevin Higgins http://www.healthinsurancecolorado.net/blog1/2009/04/10/yet-another-out-of-network-charge/comment-page-1/#comment-13106 Kevin Higgins Fri, 10 Apr 2009 23:54:00 +0000 http://www.healthinsurancecolorado.net/blog1/?p=1097#comment-13106 The below FAQ is from the DOI website. The last question would appear to mean that Humana has to process the assist. surgeon as in-network. Life, Accident and Health Managed Care - Answers to Consumer Questions Q What happens if my preferred provider organization (PPO) insurance plan or my health maintenance organization (HMO) doesn't have a qualified provider for a particular covered service that I need? Can I go to any provider without penalty? A No, but the health plan must arrange for a referral to a qualified provider and ensure that you will not have to pay more than if you had been treated by an in-network provider. Q I just found out my doctor is no longer a part of my health plan's network and I'm 8 months pregnant! I don't want to have to change doctors at this point. Do I have any options? A Insurance law requires a 60-day notice when a provider terminates or is terminated from a network and a good faith effort on the part of the carrier to provide adequate notice to covered persons. Without the required notice, health plans must make arrangements for continued care with the doctor for up to 60 days. Q I've been preauthorized by my health plan for surgery at a network hospital. What happens if the anesthesiologist happens not to be in the network? Will I have to pay out-network coinsurance for his charges? A No. All covered benefits provided at an in-network facility should be provided at the in-network benefit level. The below FAQ is from the DOI website. The last question would appear to mean that Humana has to process the assist. surgeon as in-network.

Life, Accident and Health

Managed Care – Answers to Consumer Questions

Q

What happens if my preferred provider organization (PPO) insurance plan or my health maintenance organization (HMO) doesn’t have a qualified provider for a particular covered service that I need? Can I go to any provider without penalty?
A
No, but the health plan must arrange for a referral to a qualified provider and ensure that you will not have to pay more than if you had been treated by an in-network provider.
Q

I just found out my doctor is no longer a part of my health plan’s network and I’m 8 months pregnant! I don’t want to have to change doctors at this point. Do I have any options?
A
Insurance law requires a 60-day notice when a provider terminates or is terminated from a network and a good faith effort on the part of the carrier to provide adequate notice to covered persons. Without the required notice, health plans must make arrangements for continued care with the doctor for up to 60 days.
Q

I’ve been preauthorized by my health plan for surgery at a network hospital. What happens if the anesthesiologist happens not to be in the network? Will I have to pay out-network coinsurance for his charges?
A
No. All covered benefits provided at an in-network facility should be provided at the in-network benefit level.

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