Posted by Gremlin on October 13, 2009 at 00:29:36:In Reply to: Re: Negotiating insurance over MMA posted by ejy2 on October 11, 2009 at 15:22:03:
If you know at all of my history, I am perhaps the worst result of MMA on this forum with a failed surgery. I have the "mock up" of what needs to be done by a surgeon at Baylor. However, he is out of network. No arguments have been successful for me to get his fee covered . I have Blue Cross/Double Cross, and have given up. There is a concept that is supposed to come into play called "Gap exclusion coverage"..when there is no skilled surgeon that can do job. All my explaining about this is for naught when I call the hi ups at BCBS. Ive read that there is "A fiduciary duty" on the part of insurers to cover patients needs. So, I dont know. Seems some get covered after jumping a few hoops, but i will need a check for $42k to lay on this guys table for what will be an experiment.
Good Luck.