out of network coverage

[ceejay]

The specialist who is treating me does not take
my insurance and is covered under the out of network coverage of my policy.My question is can
I try and get them pay for for 80 percent of the
surgery under the terms of the policy or will they
say it is experimental

[Terry]

What are you asking? I am unclear of what the question is. Are you asking about ADR surgery or some other surgical procedure?

Terry Newton

[ceejay]

I am talking about ADR surgery To clarify If I have ADR surgery with a specialist who does not
take my insurance and pay out of pocket,can I
request reimbursement under out of network benefits fo insurance company

[sahuaro]

It depends on your insurance policy. Also check to see if you need precertification and whether they will cover ADR. The exclusion as "experimental" would apply whether or not your surgeon is in or out of network.