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finger surgery and medical insurance



hi,

  this is regarding the medical insurance, which my company pays. i've
PPO. i recently had a minor 1-hr surgery to my finger. the doctor who
performed the surgery was referred to by another in-network doctor.
before i went to the doctor i called their surgery center and asked if
the doctor is in-network and they said he was. after performing
several tests (including blood sample) and scheduling my surgery the
doctor said the surgical center is out-of-network. then i thought it
might not be a good idea to change the surgical center as they had
done all the necessary tests etc. i asked my colleagues and the dept.
in our office that handles the med. insurance related actives how much
would i have to pay for the surgery if its out-of-network and they
said its 30%, i was fine with it. after the surgery i found out that
the insurance company does not cover that kind of surgery, and its a 5
digit amount which i never imagined, a total shock to me.

 now i don't know where did i go wrong. probably even if i had read
the book that explains the benefits i wouldn't have figured out that
my provider doesn't cover that particular surgery. i was asking
everyone just to avoid this situation. the terms that the benefit book
contains aren't so simple. the benefits summary that our company gave
us mentioned that for out-of-network my provider pays 70% and i went
by that. i would have expected the doctor to know or atleast warn me.
when i called the surgical center to find if it was in-network doctor,
why didn't they tell me that the surgical center was out-of-network or
why didn't the doctor tell me before he performed the necessary tests
for the surgery. the entire system seems to have defects. perhaps
everyone of us should have a 101 course on medical insurance. in the
end i think its my fault for not finding it out, probably i should
have contacted my provider but again will that work? btw, this is the
first time i ever used my med insurance. it was a really expensive
lesson. has anyone else been through this?

thanks for reading
-msm




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