Hi Sandy,
Our insurance denied our "out-of-network" claim when my wife and I brought our son to the Barrow Neurological Institue for his epilepsy. Our solution was actually pretty simple: we said, in essence, "Fine. If you want us to stay in-network, kindly lead us to an in-network doctor who can properly diagnose our son." We'd already exhausted the in-network options, but the committee that approves/disapproves out-of-network cases wasn't aware. They eventually approved the out-of-network visit. We still paid more than had we been in network, but at least we weren't stuck with the entire bill.
You may want to do a little research. Does your insurance have someone in-network who even does this kind of surgery? (Here in Las Vegas, we have only two - and one of them hasn't done enough AN surgeries for my liking.) If there is someone in-network, how qualified are they? Even insurance companies should acknowledge that they would want a qualified doc working on you, if for nothing else than to limit their after-care costs.
If you still find yourself being stonewalled, then I would suggest contacting an attorney who does this kind of work. Even after they approved us for out-of-network, they hemmed and hawed about their definition of 'reasonable and ordinary' billing. We were being asked to pay almost $14,000 more than was originally calculated. However, another appeal letter, which now included the phrase 'at the advise of council', cleared that discrepancy up rather quickly. Not that you want to threaten, but it helps to have someone knowledgable about the law on your side. It was absolutely worth the $1000 we paid the attorney.
Finally, my last advice is this: remain calm, and be as pleasant as possible. To the insurance company (despite all the advertising to the contrary) you are simply a number. And, at the moment, you look like and EXPENSIVE number. Talking to the insurance company in an informed, polite manner will go a long, long way. (I used to be a customer service manager - it's hard to reason with someone who enters the conversation in a hostile manner.)
Good luck, and please keep us posted!
Josh
P.S. - I've read that House is very willing to work with insurance companies. Is there someone at HEI that would be willing to call your insurance company? A phone call (or fax) from the doctor would be very helpful!
