Dr k insurance acceptance

[Kristaz]

I had RNY about 12 years ago am having issues with major dumping regardless of diet. They are very few surgeons in my area that specialize in revision so I always get the it's your diet run around. Spoke to dr K and he has reviewed everything and recommends the DS revision. My insurance has a bariatric exclusion. So I am looking to buy insurance on my own and have found several that cover bariatric surgery but they really can't tell you if dr k will be covered prior to signing up for a plan. I am in AZ - anyone that has used dr k who was your insurance co?

 

[southernlady]

Tagging @DianaCox and @Larra

 

[DianaCox]

You have to ask them - it constantly changes. And not just your insurance COMPANY, but your particular PLAN.

 

[Kristaz]

The plan I have currently has a bariatric exclusion. That's why I am shopping for an new plan but am having a hard time determining which one will cover dr K.

 

[DSRIGGS]

The plan I have currently has a bariatric exclusion. That's why I am shopping for an new plan but am having a hard time determining which one will cover dr K.

Please reread what Diana wrote.

 

[DianaCox]

When you evaluate plans, you can ask them if they cover Keshishian and if so, at what percentage. And you need to make sure the cover him as a bariatric surgeon. And you need to make sure they cover revisional surgeries. You need to ask the insco in each case to send you the full Evidence of Coverage document in order to determine what the coverage would be.

 

[Clematis]

@DianaCox She said the ins cos won;t tell her if he is in the plan unless she is IN the plan. (That can't be legal. What if the only doctors in that plan are 150 miles away?)

 

[DSRIGGS]

Diana your comment about individual plans, we found to be very true. My wife has BCBS PPO and so does my employer. The two plans couldn't be anymore different in their premiums, copays and coverages.

All I can say is that our insurance system sucks but I don't know the answer.

 

[southernlady]

So I am looking to buy insurance on my own and have found several that cover bariatric surgery but they really can't tell you if dr k will be covered prior to signing up for a plan.

Some plans are based on zip code, some on state. Even the PPO's.

Example, BCBS NC ONLY uses doctors in state as in network. I live 5 miles from another state but my only PCP option was 45 mins away in state.
Humana, on the other hand, uses your zip code. I have a pool of options in two states in a radius of about 100 miles.

Back when I moved from Tennessee to NC, I kept my oral/maxillofacial surgeon. I was able to be IN network with him on my Humana plan...which was handy when I had follow up surgery with him. The ONLY reason BCBS NC would allow me to use him was he did my original surgery, because he was in TN and technically OUT of network.

But you should be able to look up what providers are listed with a plan. EVEN if not yet signed onto the plan. I know I do all the time when I am faced with changing /staying with a plan each year.