doctor out of network?

I just received an email from the doctor that my PCP told me to go see saying he was out of network for my insurance but that he does see BC/BS patients....this is what he said partially...

"Initially you will need to pay $212 for the consultation and then pay before surgery: $5500 for laparoscopic gastric bypass surgery; $3488 for Laparoscopic Lap-Band® or Laparoscopic sleeve gastrectomy; $7500 for laparoscopic duodenal switch with BPD. BC/BS will then reimburse you by sending you a check to your home that is based on your benefits after you file the consult fee and then the surgeons fee's (again the hospital and anesthesia fees are covered if they approve you for surgery).


(one example is: 80% paid out of network fees after a $200 a year deductible and $50 copay up to a maximum of $1500 out of your pocket and then the plan pays the rest of the customary charge)."

does this sound reasonable?

I also went to an out-of-network surgeon. All pre-approved since both he and the hospital were accepting what the IN-network fee schedule was at that time.

The monetary amounts don't sound out of line. And many medical offices have become fed up with the way carriers give them the run-around even if they ARE going to pay.

Make sure your policy stated benefits are clearly stated and your carrier gives specific authorization to this provider, or you may get an unpleasant surprise come bill-time.

good luck on your journey

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Thread Starter

thanks...I have just contact my insurance company to find out which doctor's are in network...also, I am scheduled for a preop for tomorrow for hand surgery for a workers comp injury so I may ask this doctor if he can recommend any doctors....thanks!