Update and questions

[weaura]

I heard back from Matthew with Dr Rabkin's office regarding what my insurance covers. Dr Rabkin & Dr K are both out of network for my insurance. We've met our deductible and aren't too far from meeting the out of pocket amount. Matthew said the insurance will only pay an 'approved' amount. Does that amount just vary from insurance plan to insurance plan and employer to employer? Is there any way to find out up front what that's going to be?
Both Dr K's and Dr Rabkin's office say all the hospitals they each use are in network, but that confuses me. Since I'm insured in OR, how are hospitals in CA considered in network? (I have Cigna through Intel.)
I plan to contact Dr K's office tomorrow to see if they received the CD of my UGI yet and if yes, has Dr K looked at it yet? And I'm waiting to hear back from Dr Rabkin's office to see if he's willing to consider me as a patient. I know about Dr Rabkin's upfront fee, but Dr K's office hasn't told me about any upfront fees he may have. Does anyone know if there is such a fee with Dr K? Should I also expect to pay him more than what the insurance 'approved' amount covers?
Thank you all for your patience with my questions. I'm not sharing this journey with anyone other than my husband. He's a wonderful man, and very loving and supportive, but can't answer any of these questions.

 

[Cantstalkthis]

Hospitals are usually part of a network even if they have different names. Also, you could break your leg or have a heart attack on vacation and they want to bill insurance rather than have an unpaid bill that you'll never be able to cover. The trick with deductibles is that most insurances have a tricky in-network max and another max if you're out of network. Ours is something like $4000 family, $1500 individual if we're in-network or $15,000 family, $5000 individual if we're not. HUGE difference. It's actually cheaper for me to pay cash (and get the cash discount of 40% or so) than to use my insurance for something that isn't in-network as long as it's below that $5000. The insurance doesn't do a great job of negotiating down anything that isn't in their network.

Your experience may be different but I would triple check on that deductible and out of pocket max to see if it only applies to in-network services.

 

[weaura]

Hospitals are usually part of a network even if they have different names. Also, you could break your leg or have a heart attack on vacation and they want to bill insurance rather than have an unpaid bill that you'll never be able to cover. The trick with deductibles is that most insurances have a tricky in-network max and another max if you're out of network. Ours is something like $4000 family, $1500 individual if we're in-network or $15,000 family, $5000 individual if we're not. HUGE difference. It's actually cheaper for me to pay cash (and get the cash discount of 40% or so) than to use my insurance for something that isn't in-network as long as it's below that $5000. The insurance doesn't do a great job of negotiating down anything that isn't in their network.

Your experience may be different but I would triple check on that deductible and out of pocket max to see if it only applies to in-network services.

I hadn't even considered that, thanks. I will definitely check on that.

 

[southernlady]

You can usually force IN-Network coverage if there is not an In-Network within 50 miles of you to do that exact surgery.

 

[weaura]

The Bariatric Clinic here at OHSU sent me a letter stating that after their review "of my medical and mental health history" they do not believe surgery is in my best interest. Based on that, do you think I could have Dr K or Dr Rabkin covered as if they were in network? That letter made me mad. I don't know what mental history they are referencing.

 

[Charris]

Dr k no longer has the 4000 program fee I had to pay in Oct 2013.

 

[weaura]

You can usually force IN-Network coverage if there is not an In-Network within 50 miles of you to do that exact surgery.

How would I go about getting that done? Is that something I ask Dr K's or Dr Rabkin's office to do or is that something I do myself?

 

[weaura]

Dr k no longer hals the 4000 program fee I had to pay in Oct 2013.

Yay for that!

 

[southernlady]

How would I go about getting that done? Is that something I ask Dr K's or Dr Rabkin's office to do or is that something I do myself?

That is a trick that @DianaCox used to force her insurance to pay for Rabkin as IN network, he was just a fuzz over 50 miles from her house. She knows how to handle that one.