Insurance Craziness

[JudyW]

I guess I have been sort of spoiled by having my low back problems be workers comp. California workers comp is completely screwed up but eventually, years later, they do pay for your procedures. I'm going through my regular insurance, PORAC Anthem (blue cross) for my cervical issues. I had eight facet injections a few weeks ago which had limited, three days, of pain relief. My doctor, Dr. Sten Kramer, requested a radio frequency thermocoagulation procedure on the same areas. I received a call from the Newport Surgery Center where they stated that the doctor was out of network and therefore I would need to pay $350 up front with a $1500 "rule". She said Anthem will only pay $540.00 at the most which would mean I would be responsible for the rest up to $1500.00 and I would need two of these procedures. Yeah, I don't have $2000 laying around to throw out on a procedure that may or may not work. Thankfully I called blue cross and they told me the doctor is not out of network the surgery center is. Then the, surprisingly, nice clerk told me all they have to do is request some type of referral stating that this is the only facility the doctor can perform that procedure at and then anthem will pay for the whole thing. I was suppose to have the procedure tomorrow but since I thought I was going to pay $1000 I cancelled. I have since left a message with the moron at the surgery center with the information I discovered. I find it hard to believe she didn't already know about this caveat, but then again..... I guess they assume people won't go the extra mile to discover these little ins and outs of the system. My message would be to everyone that you should call and push as much as possible. I would have just gone on in pain until I was in severe pain before finding a way to come up with the money. Hopefully this new strategy works.