Out of network
Out-of-network denials
If you have an HMO—your insurer will deny all treatments that are out of network. The insurer wants you to use an in-network doctor because they control how much he gets paid—and what he can prescribe.
You don't have to submit to insurance-company control. Write a proper appeal and make them cover your out-of-network treatment.
Prove that the in-network doctors are dangerously unqualified and inexperienced. Prove that your out-of-network expert is so qualified that he walks on water. Prove that the insurer has paid for this treatment out of network many times before.
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Out-of-network approvals
I am probably the only person in the U.S. who appeals approvals.
Out-of-network deductibles can be as high as $35,000. Out-of-network co-pays are higher, reimbursement percentages are lower.
If you don't appeal the out-of-network approval and change it to in network—you could be responsible for 90% or more of the bill.
Prove the same points as above. The one difference is that no insurance company will accept an appeal of an approval. My trick to getting insurers to accept them is simple: Don't call it an appeal.
Call your appeal a "Request for Reconsideration." Works every time.