The games that many health insurance companies play make doctors wary of becoming a “Provider.” Provider status is nothing more than a contract in which the doctor relinquishes quite a few rights, for example the right to determine what a service should be paid. I am selective about contracting with health insurance companies for this reason. And I still do some work for insurers to which I am not contracted.
How can this work?
Some of the surgery I perform is not elective. It involves hospitalized patients who have wounds that won’t heal (or haven’t healed) without surgical help. In some of these hospitals I am the only plastic surgeon on staff.
Why does this make a difference?
If you need surgery and the only available surgeon is not a provider for your insurer, you will find your insurer may be willing to make an agreement with the surgeon for that one case. My office interfaces with the insurer and often we come to an agreement and are able to do the operation as a covered benefit. Some insurers are more receptive than others. Others simply offer an unacceptably low rate knowing no good surgeon will take it.
This is not 100%, but can work. Some patients have actually called their human resource departments at work and helped the process along too. The fact is that surgery costs your insurer money and without some pushing you might not get it. Be prepared to get involved if you want better care.
Best Regards,
John Di Saia MD
Originally posted 2011-05-05 07:30:55.
It is usually a matter of what they will pay and when.