Question:
my company just changed me from Anthem to Oxford, with a exclusion clause...help!!!
i am a week awy from pre-op meeting and lb work, ect with a tenta tive surgery date in Feb and all of a sudden I was informed that my company is dropping Anthem and going to oxford with an exclusion clause...what do I do now?? Very Disenchanted!!! — dreaspace (posted on January 20, 2006)
January 20, 2006
Hi Andrea
Very important question is: were you already authorized by the old
insurance carrier? If so, the new carrier has to honor their decision. i
know, mine went from blue cross HMO to PacifiCare HMO after i had been
authorized- and it was honored. It would have been honored even if it
hadnt been authorized first,, because my medical group whom I worked for,
always made sure when we changed, we changed with the same plans except for
maybe a small difference in the co-pay. If you had alrerady been
authorized, make sure this new insurance carrier has all of the info from
the old one- and that the person in your HR office takes care of the
glitch. I wish you great luck on your surgery- do not give up- this is
just one bump in the road. If you need any more help give me a holler, I
am pretty good at making insurance companies sit up and take notice- they
hate pushy doctors :)
Cindi
-217#
— DollyDoodles
January 20, 2006
Hi Andrea
Very important question is: were you already authorized by the old
insurance carrier? If so, the new carrier has to honor their decision. i
know, mine went from blue cross HMO to PacifiCare HMO after i had been
authorized- and it was honored. It would have been honored even if it
hadnt been authorized first,, because my medical group whom I worked for,
always made sure when we changed, we changed with the same plans except for
maybe a small difference in the co-pay. If you had alrerady been
authorized, make sure this new insurance carrier has all of the info from
the old one- and that the person in your HR office takes care of the
glitch. I wish you great luck on your surgery- do not give up- this is
just one bump in the road. If you need any more help give me a holler, I
am pretty good at making insurance companies sit up and take notice- they
hate pushy doctors :)
Cindi
-217#
— DollyDoodles
January 20, 2006
Andrea,
What about COBRA? Can you opt to pay the premuim (plus 7% or something) to
Anthem directly? You are SOOO CLOSE!!!
— cheide
January 20, 2006
Hello Andrea,
The first thing to do is take a deep breathe and let's think things
through. First thing is first, as previously stated if your surgery has
already been approved by Anthem then you do not have anything to worry
about because Anthem will have to honor the authorization. Secondly, when
does the change over from Anthem to Oxford take effect? It is already late
January so I highly doubt that it is Feb 1st, which means that it will more
than likely be March 1st at the earliest. The only concern I have at this
point is your follow-up appointments. It is very well possible that you
current surgeon may not be a part of Oxfords network which would cause you
to either one follow-up with a general surgeon that is in their network or
two pay out of pocket if you want to continue with your existing surgeon. I
would first find out if your surgeon has already gained authorization for
the surgery and secondly I would not mention the insurance switch to
him/her just yet until after you know something for sure.
I hope this helps ...
Tiffany
— Tiff's On a Mission
January 20, 2006
I agree with Tiffany about the insurance changing issue. If it doesn't
change until March your fine. When insurance is billed for the surgery
part of the bill is your immediate follow up care, normally for 3 months,
so initially you wouldn't have any co-pays and then after that period of
time when there are no complications then you would need to decide if they
will cover your regular appointments or if you would need to pay out of
pocket. My surgeon only charges 50.00 for follow up appointments so it's
not normally that bad. Good luck with your journey.
— dlryanoates
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