May 9, 2008, Newsletter Issue #127: See A Specialist

Tip of the Week

Sometimes an out-of-network specialist can save you more than the “in-network primary care doctor.” Generally, a specialist is far more experienced in performing certain procedures in their specialty thus that is why they are called specialists. They know what tests to order and what tests are a “waste of time and money.” If you have a condition, such as Crohn’s disease, and know a Gastroenterologist who specializes in Crohn’s disease, it's worth calling your insurer's pre-certification department to explain why using the out-of-network provider is essential and ask for coverage at in-network rates. In most cases, insurers would rather strike a deal up front than go through an expensive appeals process. Just be sure to get everything in writing as soon as the deal is made. The Kaiser Family Foundation at www.kff.org has a consumer guide explaining your rights to appeal disputes with health plans.

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