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Ms. Toad

(34,375 posts)
8. Apply for coverage out-of-network to be treated as in-network.
Wed Jan 3, 2018, 08:20 PM
Jan 2018

For extraordinary circumstances (shortage of in-network physicians, ongoing care for an acute condition, etc.) you can often continue to be cared for until the resolution of the problem by out-of-network providers as if they are in network.

Review your insurance contract. Contact customer service & ask them how to appeal for out-of-network coverage. You will need the cooperation of your physician to appeal - to make the case that these are extraordinary services, and that the cost (in loss of the limb, if nothing else) will be more severe if you aren't provided with access to the doctor (I have had numerous doctors do this - either for out-of-network care, or for coverage of off-formulary prescriptions, or treatment considered experimental). I don't appeal everything - but I have yet to lose any appeal I seriously pursued. (One appeal I gave up, because at that time the additional cost of less than $100 wasn't worth the time it would have taken to appeal.)

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