Insurance

[sharone143]

I had my heart set on having surgery at the House but after months of waiting, Blue Shield has denied my insurance because it's out of network.  Does anyone think that I should file a grievance?  or will I just be wasting my time?  I had it all planned out and was going to schedule surgery in August.  My other option would be to have the procedure done at Stanford but I had heard some disappointing experiences from past patients.  If anyone can shed some light on this, I would great appreciated it!  Thanks!!

[pjb]

I had my heart set on having surgery at the House but after months of waiting, Blue Shield has denied my insurance because it's out of network.  Does anyone think that I should file a grievance?  or will I just be wasting my time?  I had it all planned out and was going to schedule surgery in August.  My other option would be to have the procedure done at Stanford but I had heard some disappointing experiences from past patients.  If anyone can shed some light on this, I would great appreciated it!  Thanks!!

I would definitely file a grievance and see if HEI will work with you and accept whatever the out of network BS will pay them with your plan. This is major major surgery and if they do not have a larger lists of experienced doctors in this field we they want to take a chance if they were in your shoes?

Best Wishes,

[Archer]

My insurance is Blue Cross Blue Shield of North Dakota.  I just had surgery done at House and it was covered.  Both House and St. Vincent work with BCBS.  It was approved and I confirmed what my coinsurance would be before I went there.  I'd check again and appeal if necessary.  House is worth the effort.

[leapyrtwins]

HEI is definitely a good place, but there are many, many other good places.

Stanford has an excellent reputation. 

Jan

[lrobie]

I have BC/BS PPO Blue and I'm being told that my surgery scheduled for July 18th at House is covered.  Do you have a different plan?  Who checked with your insurance?

Lisa

[jaylogs]

Like Jan said, there are definitely other options so if this doesn't work out, don't dispair too much!  I would try to work with House and file your appeals that you need to. Let us know how it goes!  Take care!
Jay

[sharone143]

Thanks all!  I have Blue Shield HMO.  I filed a 72hr grievance based on current symptoms (vertigo, severe dizziness, tinnitus and headaches)  that are preventing me from taking care of my children on a daily basis.  It was denied today and will go to the 30 day standard appeal.  I'm planning on writing an appeal letter, submitting Dr Brackman's letter and all of his written literature.  Can anyone offer other tips for fighting this? 

SD

[Jill Marie]

As another one said, see if HEI will accept whatever BS will pay.  I had my surgery 20 years ago in Seattle, WA and was told the doctor I wanted wasn't in network.  He told me NOT to schedule with another doctor tell I gave him a chance to get the assisting doctor and the hospital to accept what my Insurance would pay.  They thankfully all agreed as when it came time for the surgery it wasn't what they thought it was and the doctor that would have operated on me wasn't qualified to do my surgery. 

Sounds like you have gotten some pretty good advice so far, whichever way you go, Stanford or HEI I hope all goes well.  Jill Marie

[It is what it is]

So what happened with your insurance?  I hope it worked out in a positive way for you. 

My surgery is scheduled for 8/1 and I was told by HEI that everything was a go with my insurance.  Then only in the last couple days my insurance told me I did not have prior authorization.  We scrambled quickly with HEI faxing required information so the medical review team could make an expedited decision which they just made this morning.  Fortunately, it was approved. The doctors are out of network but the hospital is in network for my out of state insurance. 

karen