Health insurance hand wringing
February 16, 2014 8:00 PM Subscribe
Could a specialist on the other side of the country still be considered in-network?
posted by mermily to Health & Fitness (17 answers total)
An ENT I recently saw has suggested based on the pathology results they've gotten that I have a super rare tumor (likely benign) on a cranial nerve which will require a surgical procedure that usually requires the sacrifice of the nerve the controls your vocal cords. It is a "schwannoma" on my vagus nerve. From what I've read, the results of the surgery can range from outstanding!, no after-effects! to extensive neurological damage that would include drastic changes to my voice, ability to swallow and taste and effects on my facial nerve and ability to orgasm(?!) to boot. Because the type and location of the tumor is very rare, there are apparently very few surgeons in the country with significant experience operating on them and using the specific surgical methods which tend to preserve the function of the nerve.
I'm essentially a medical insurance newbie as I am thirty one years old and have never personally had a medical condition more serious than belly button lint. I am a (North Carolina) teacher and have what seems to be a kind of crappy PPO through Blue Cross Blue Shield of North Carolina.
I have been combing through Google and apparently there are doctors at Columbia and Stanford that have experience and good outcomes with these surgeries. I know Blue Cross Blue Shield is a widespread health plan, but it seems like there are subsidiaries(?), e.g. Blue Cross Blue Shield of NC. If I consulted with a Blue Cross doctor in, say, California, would that be considered in network because it's Blue Cross, or out of network because it is Blue Cross Blue Shield of some other region?
I'm wondering if a cross-country doctor could still be considered in network if my insurance provider is a huge one like Blue Cross? I hope that question makes sense.