AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question My husband and I have been seeing a Dr. that is out of our network, in the past we were able to have our chosen physician give us a referral and the insurance would cover. Recently, we were told that the policy had changed and that the DR. we wish to continue seeing only accepts my insurance company's PPO plan. I am with an HMO. What would my Dr. have to do to accept the HMO if he already accepts Cigna's PPO?
Answer Hi, sorry I do not have much experience with HMO's. When the providers contract with HMO's/PPO's it means they are willing to take write off's and a lot of times it is quite a significant amount. Usually, Kaiser and such HMO's have their own physicians which means, I believe, that they are actually employed by Kaiser and it is not just a contract like when a Dr has a contract with a PPO.
I have seen in the insurance companies that I worked for that if there are no other providers within a certain amount of miles or within that profession that can also help you, we sometimes, made exceptions and a note was put on the system indicating that if any claims came in, we were to have them processed toward their in network benefits instead of their out of network benefits because the Case Worker made a network exception.
Which sounds like what you have done in the past, sort of, by having your physician write a referral. I don't think you will have much luck if you are in a HMO but you may ask for an exception to be made if you have some good reasons for them such as no other provider specializes in the type of care you get from that provider. You are unable to travel to a different provider, etc.
