Insurance coverage - out of network question

[Tbanis2463]

I have Cigna insurance to cover some of my radiation treatment of acoustic neuroma.  My family doctor is considered "in-network" and sent me to a place for a consultation with a radiology doctor that was "in-network".  I was sent to Roswell to have my procedure done.  I received a notice that I am approved for coverage but will be considered "out of network" and therefore will end up paying more because of this.  Is there anything I can do to dispute this to have it covered as "in network"?  after all I really had no choice in the matter.

[skipg]

In my case I was denied any treatment at an out of network facility. We ended going to a 3rd step appeal and the denial was overturned and the treatment will be covered as if it is in- network. Talk to your doctors and your financial case worker, they should know how to make an appeal on your behalf. I am sure you will get some sort of relief and make sure you keep all correspondence from your appeal process. May God grant you favorable results.
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[geexploitation]

If you haven't talked to a case manager or patient advocate within Cigna, do so. Same goes for the hospital at which you're getting treated -- they can help too, sometimes.

Without knowing exactly the reason behind these moves by your insurance company, keep in mind that you can appeal. Also keep in mind that, at least for some insurance companies/policies/areas, if your options are limited as far as places to get treatment you can petition for someone normally considered out-of-network to be considered in-network for you.

Also, you should check to make sure that you have to get treatment locally. If your network is actually national that can open up a world of treatment possibilities.

[Tbanis2463]

I followed up with a few phone calls and the decision was reversed.  Thanks for all the input