A little background. I've been dealing with a health issue for several years using medication to control my condition. After countless drugs and horrible side affects and poor results, I've decided to get surgery and eliminate the problem. I will need two or possibly three surgeries to get back to 'normal'. During this time working may be impossible or limited. I should be able to get by on savings to get through recovery but not if I have problems getting insurance to cover the surgeries.
So, Let me see if I can get this right. I have medical mutual (mercy Health) through Obama care. The local Mercy hospital does not do the surgery. Cleveland Clinic is the place to go. They are rated 2nd in the country for the procedure and its about an hour and half away. The problem is that because I dont live in the cleveland area, the clinic is considered out of network even though the clinic is part of MM and mercy health. Next option for the surgery is in Cincinnati which is over 4 hours from me but it is actually considered in my network.??? Cincinnati does not have nearly the experience with the surgeries. They are rated pretty low for the procedures. My doctor doesnt think I will have an issue getting insurance going to Cleveland with his referral. I dont have his confidence.
I intend to contact the insurance co. to find out what they will do but I want to ask the right questions and hopfully keep my frustration in check. I'm hoping someone on here has been through a similiar situation and can somewhat point me in the right direction.
I'm sorry for the long post and this might be an unusual place to ask for help but this forum is full of informative and intelligent people and I value your opinions.
Thank you for any help offered!
have your doc make the referral to cleveland clinic. Then, when you are scheduling your first appointment with CC, tell them the story and give them your insurance info. You can let them know you want to have everything financially figured out before you start treatment.
They will do a lot of the legwork for you in figuring what will be covered and how to get the correct pre-auths and documentation. A - they do this all day long, B - it is in their best interest to figure it out for you and get you approved. Similar to how a finance department at a dealership will work really hard to get you approved for a loan. CC doesn't want you going to Cincinnati over them either.
That’s encouraging. Thanks!
As for the time off work, check to see if your employer has disability insurance
T.J.
MegaDork
5/4/18 4:46 p.m.
My father-in-law had successful heart surgery recently at Cleveland Clinic that went well. So, just an anecdotal recommendation for them.
In reply to stuart in mn :
No disability insurance
In reply to T.J. :
Thanks! I’m pretty confident in the CC doing the procedure I’ve had friends and family with goods results from them. I’m just hoping insurance will cover me at the clinic.
What Robbie said has been my experience as well. If they've already OKed it for one facility even better. The Cleveland Clininc should be able to do most of the legwork to keep your business and if they can show that they have a higher success rate and you'll be closer to home it shouldn't be a tough sell since that can improve your outcome making it less likely you will need any corrections later on. As for the disability it's probably too late now but a private disability policy is a good idea. We don't get insurance through work so I've gotten paid by the duck a few times when I've been hurt.
