House is out-of-network, attempting to get in-network

[michellef08]

Hi, I'm new to posting, but have found a lot of great information here.

I was diagnosed with my 1 cm AN in December 2012. It is on my right side and my symptoms are mild hearing loss and tinnitus. I have scheduled surgery at House on April 10 with Friedman/Schwartz. Dr. Schwartz wants to do more tests (balance, brainwave, closer MRI) during pre-op to decide between middle fossa and retrosigmoid.

House and both doctors are out of network for my insurance (Aetna PPO) and I was wondering if anyone has an advice/tips about trying to get the surgery covered as in-network? I've already called my insurance and obtained a nurse case manager. She seems great and is starting the process for me. I know I have a little while, but wanted to start the process as soon as possible as I've read it can be a pretty painful and long journey.

I had originally scheduled surgery at Hopkins for retrosigmoid (in-network for my insurance). But after further research, decided to go with House since I could be a candidate for Middle Fossa and hearing preservation is important to me.

Any advice would be much appreciated. Thanks!

~Michelle

[neetze1]

Michelle, have you asked the person from the business office at House, or the sheduler?  I am going there in March.  Lucky for me, I had just switched form Aetna during our open enrollment period (before I had any idea I had an AN) and boy am I glad I did!  I am covered as in network but they told me that they even get HMO's to cover because they have less complictions than other hospitals and it utlumately is less costly for them to cover the surgery at HEI.  I would talk to House and see it they can help you.
Anita

[CHD63]

Good advice for Michelle, Anita.  The House insurance people were wonderful to jump through all of the hoops necessary to obtain coverage.

Many thoughts and prayers.  Let us know!

Clarice

[michellef08]

Yes, I have spoken with the House insurance lady who told me she has nothing to do with it and I would have to take it up on my own with Aetna. My surgery counselor seems to be even less help.

Luckily my nurse case manager at Aetna seems great and is getting the ball rolling.

[neetze1]

How are you making out Michelle? Any luck? 
I did notice that HEI is not great in returning phone calls.  I think they are understaffed.
I was dealing with "Rita" who is very nice but she just went out on a medical leave herself.  She was the one who would call me periodically to see if I had any questions.  She was the person that told me they often get HMO's approved because it is ultimately less costly for them to have it done at HEI. It's  a shame she is away right now.  I think Aetna is just having problems all over right now.
I live in NJ and some of the major hospitals in my area will not accept Aetna right now.  They do not pay the hospitals enough!

[michellef08]

No luck, thank you for the concern!

Yes, I been told multiple times that they are understaffed (in the few times they have called me back).

I wish Rita was there now, it sounds like she was great.  I have been speaking with Yvonne who told me and Aetna that because there are Aetna in-network surgeons at House, I cannot apply for an in-network exception. She acts like switching surgeons can be done so easily, she asked if I wanted to keep my surgery or switch. I obviously chose these doctors for a reason.

So I guess now all I can do is see what the cost estimate is, and ask if they will accept the full out of network payment and not balance bill me. I don't really see that happening though.

[neetze1]

Michelle,
Sorry you are having such a hard time!  I hear from these boards that all of the surgeons at House are good.  If there are some that are in-network, you might want to consider switching.  Better to go to a different Dr there then to one someplace else?  (I hope)
Dr Luxford and Dr Lekovic are doing mine. They are not the most well known but I have faith in them.
Good luck!
Anita

[geexploitation]

Any reason you have to go to House? I had surgery last year, through the Aetna network, and there are a lot of great surgeons in that network. If House is out-of-network for you and you're concerned about the financial cost, why not look elsewhere? I know it's no fun to rethink this kind of thing, but these surgeries can get very expensive, so I would think staying in-network would be a good idea.

[michellef08]

Thanks for the advice and support!

Actually, I finally got in touch with the right people at Aetna and got everything approved as in-network!! What a relief! Now just waiting.. 9 days to go!

Anita- I hope your surgery went well and you are recovering quickly!