Posted by sick&tired on February 24, 2009 at 12:21:46:In Reply to: If you can't afford Dr. K. Ly? posted by num-numbs on February 05, 2009 at 10:43:16:
I had two surgeries with Dr. KL; one was MMA. I also have UHC, PPO. They paid everything 100% after my deductible.
He is considered out-of-network by UHC, but you can request they pay as an "in-network." This is done by requesting "Gap Coverage" at UHC. You will have to call their CUSTOMER CARE dept and have explain why he is the only doctor you can go to that performs this surgery FOR sleep apnea. They can approve or reject it before your surgery, so you will know. If they reject it you can call back again and submit whatever needs to be submitted for proof. You will also want to tell Juanita at Dr. KL's to submmit the gap request with your surgical pre-auth. I have had multiple surgeries for sleep apnea, and have gotten UHC to pay in network for all.