Can anything be done if no reasonable in network available?

[goillini52]

I already did that when I got turned down from my docs offcie few months ago I may try again now with this situation with me son though

Working on a network extension appeal form from ins co now though got this today

That's terrible that you're paying all that money for health insurance that you can't use.

 

[Life Hawk]

But isn't the Ins company supposed to provide and in network option or cover out of network as in network if there is no in network option available?

So sorry to hear all of this @vic120 . The frustration you must be in at the moment can be overwhelming.

I am making a suggestion in hopes that at least you might find some way forward. I am not the expert in this field, but fully understand that back channels are often how things get accomplished.

If, and it's a big if, you could get someone from the out of network hospital to advocate your situation to your insurance company, perhaps there may be some wiggle room. I know what many are thinking, but it's worth a try. This is how many of the co-op health organizations work to provide coverage for their folks. The premise is that someone wants to get paid.

I pray that your family make it through this spot in the road and that your son finds the healing you are searching for.

 

[vic120]

That's terrible that you're paying all that money for health insurance that you can't use.

My sons therapy's have been in network is the reason I didn't notice in jan or before

that is half the family deductible and coins ins done in early feb so theres that

 

[LeeV]

Vic120, i feel for your situation. 2 things came to my mind as I read this thread, and keep in mind, that I do not have anywhere near the information required to make me confident in my reply. The first is that you will need to appeal the decision of the carrier. May work, may not. The second is your description of "reasonable network available" in the post. Keep in mind that your definition of "reasonable" and the carriers' may very well be drastically different. Best of luck.

 

[vic120]

Vic120, i feel for your situation. 2 things came to my mind as I read this thread, and keep in mind, that I do not have anywhere near the information required to make me confident in my reply. The first is that you will need to appeal the decision of the carrier. May work, may not. The second is your description of "reasonable network available" in the post. Keep in mind that your definition of "reasonable" and the carriers' may very well be drastically different. Best of luck.

if this helps my def of reasonable is a hospital equipt and willing to take in a special needs child non verbal and flight risk

UT is in network but wont take him because they are not equipt

we set up with them but they called back and cancelled for this reason

My wife said she would stay and stay awake the whole night as it will be an overnight but they said that he needs a hospital that can handle it they cannot

 

[Central1980]

I would start by appealing the plan to cover the procedure as in network being there the is no other option. Being off exchange you have no appeal process with healthcare.gov, if you were on exchange I believe this would be grounds for a special enrollment period, this would allow you to choose a plan the would cover the hospital your looking for. Have you spoken with hospital about the issue. I find this so odd that a hospital would not be in network with Blue Cross. I can try to help, provide me your zip code , and name of plan your on along with name of hospital your looking to utilize. I can do some homework and atleast point you in the right direction. When is your sons procedure scheduled? Can you email me at [email protected] ? My name is Jonathan

 

[Yagents]

A little birdie told me that the MP is not requiring proof of LOC docs