Doctors are referring me to an out-of-network surgeon when there are surgeons that are in-network, but not as experienced. Insurance isn't covering any of it and it won't do to my OOP deductible. Is it worth filing a Network Deficiency claim?

I am in need of orbital decompression surgery. I have genetically large eyes (confirmed by MRI) and suffer from Lagophthalmos, which has in return caused some chronic conditions. The last few years of my life have been miserable. I have 4 eye doctors all trying to treat my eyes. The answer is orbital deconstruction surgery.

The issue is that I have two doctors telling me to travel out of state to see the best of the best, who doesn't accept insurance. There are a few local surgeons here that do the surgery but not very often so there is a much higher risk. The doctor I am being referred to does these surgeries every day and has a great record with patients like me.

So my question is, is there any hope to file an appeal for network deficiency with insurance for coverage? I have two doctors willing to write a referral stating why I need the surgery and why they recommend this specific doctor but I fear it's not enough.

https://ift.tt/fH78YPl Submitted December 03, 2022 at 03:47AM by KDWWW https://ift.tt/JKxApY4