Amputee Treatment Center Forum

INSURANCE COVERAGE & ISSUES => Insurance Coverage => Topic started by: pegleg jack on February 07, 2009, 10:43:32 AM

Title: out of network doctors
Post by: pegleg jack on February 07, 2009, 10:43:32 AM
have found out and am fighting it right now, my CPO, is not in the net work of providers listed by my insurance company and they will not pay for my having a new pair of legs made by the person that i trust to do it, they want me to go to another place that i dont know if they are any good.
Title: Re: out of network doctors
Post by: ann on February 08, 2009, 10:01:28 AM
PLJ,

Sorry, but I assumed you were on medicare...so far they have been very good about paying 80% of mine..well, actually this is one of the gold plans that replaces it with more benefits. {I think} .......no questions asked.
Title: Re: out of network doctors
Post by: pegleg jack on February 08, 2009, 10:14:16 AM
Ann, i am on MEDICARE, and have a supplement insurance that pays what MEDICARE dosent, and they have there network set up and you have to use the doc's and facilities that they have listed in thier annual booklet they send out, and they pay 90% on my legs, but the reason i want to go to my old CPO, is because she knows me and my stumps, made a pair of sockets for me and the first time i put them on they felt like i was putting on a old comfortable pair of shoes, she only had to adjust them once and i had no trouble after that, and i dont really want to break in a new person at this time. The other two shops up in TYLER, TEXAS, (that is where we have to go, for there is no one here in town that does this.) and i have not had or talked to anyone that has used them so i dont know if they are any good or not, So i can hope that you see my point in fighting them to let me use my regualer CPO.

P.S. this insurance company is also my part "D" for drugs.
Title: Re: out of network doctors
Post by: herb on February 09, 2009, 11:23:38 PM
Hello Jack - I have run into the same problem and have had to pay a greater co-pay. But I was able to get my provider to do the paperwork to join my insurance company's network. good luck, herb
Title: Re: out of network doctors
Post by: pegleg jack on February 10, 2009, 09:31:24 AM
Herb, that is what we are trying to do now, so that i can go to her. and thanks for the input.