I just got an explanation of benefits from my insurance company declining payment for my last visit to my surgeon. I don't have out of network benefits and he's now out of network. They didn't mention it when I was there 3 weeks ago. Now I have to find a new surgeon and start fresh. On one hand it's partially my fault for dragging my feet on the other hand I'm bummed that they didn't bother to mention it.

The surgeon I used for my second opinion is out of a hospital I'd rather not go to. It took me so long emotionally to get to this point and now I'm back to square one. Is there a part of this forum that discusses surgeons so I can get some input?

Kathy

Kathy, this pre-op section is where you would discuss the problems you are now having with your doctor, so you posted the thread correctly.

Boy, I'm so sorry to hear about your situation. Hindsight isn't really worth much, but most insurance companies publish a benefits booklet in the late fall that tells of any changes in benefits. Usually they will also list the doctors who ARE in their network (they won't bother with who they've dropped). It always pays to check these documents to see what changes in coverage are taking place and whether your doctors are going to remain available to you. You'll want to do this from now on. Policy changes usually take effect on January 1st of each year.

As for what to do now, I don't think you have any option but to go with whichever doctors are in your network. Find that list for 2010 and start interviewing them. There may be some surgeons on the list for this year that weren't there when you did your initial search last year.

I know this seems like a real pain and duplicate work....and it is.....but you can do it. You can find another doctor that you are satisfied with. Once you locate that person, have all your films, tests, and medical records from your old surgeon transferred over to the new doctor. You'll get there, but you need to get busy!!

In the USA, our health care system requires people to be their own advocates. It's a tough lesson, but I know you'll be a more aware and informed patient from now on! We'll be here for support to get you through it. Please post again and keep us up to date....we care about you!

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RTKR - February 29, 2008

LEGAL DISCLAIMER - Moderator comments on this web site are provided for informational purposes only and are not a substitute for advice from your personal physician or surgeon.

That sounds like a real bummer! Hope you find a new surgeon really soon.

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Please post in forums; PMs and emails for personalized help are not community oriented and will not be answered. Also search the Library and other threads for information.Thanks.

LEGAL DISCLAIMER - Moderator comments on this web site are provided for informational purposes only and are not a substitute for advice from your personal physician or surgeon.

Administrator is an orthopaedic nurse of 50+ years experience in joint replacement.
Left arthroscopic menisectomy 4th October 09
RTKR 17th March 09
Right arthroscopy June 06

I went through the same thing on my hip .. was to get done Nov 2009 and had to reschedule for Jan 7 2010. My doc was on the list but the hospital was out of network.. so had to get a new date for the hospital..
Good luck and sorry you have to start over..
Pilot1

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LTHR 1-7-2010
RTKR coming up on 4-26-2010

That really stinks...sorry you are having to find a new doc. Bet you new doc will be absolutely awesome!!!!

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Barb
R Total Knee: 4/14/09
L Total Knee: 2/9/10