CF Care is out of Network

[bloggymom]

I am 50 with CF. My pulmonary doctor suddenly no longer feels comfortable treating my CF. We have been going to see him rather than a CF doc at a CF Clinic is because CF docs and their facilty are out of insurance network (as is official "tune up" hospital location).

I spoke with Compass and they offered to help... per their guidance... I called the CF team to see if they would help me get a waiver or something to convince my insurance company to allow me to get my care with them. Clinic said they cannot help with that process. I would have to pay for all my CF care out of pocket. The next step is to find a pulmonary doc in network....I cannot get a hold of my PCP to get a referral. He won't answer messages that I leave for him online or with his nurse. Great!!

What do I do if we can't get a referral from PCP?? Most lung docs in my area won't see me with CF.... they insist that I get my care at CF clinic but... clinic is out of network. Vicious never ending cycle.

Am I really out of options for lung care??

 

[dbtoo2]

Every insurance company has an appeal process. You can start with that. Another consideration might be Healthwell Foundation, or one of the other organizations that provide funds for CF and other diseases. They may be able to reimburse costs up to their max amounts (depending on your income of course.)

 

[Ratatosk]

How much is the deductible or out of pocket cost if you go out of network? We had similar issues when DS was younger but it was a matter their being an unaccredited clinic in our town and we preferred driving to the City a couple times a year instead and just paid a little extra for office visits. Inpatient was covered the few times he had to be hospitalized as he ended up having surgery for a bowel obstruction.

 

[bloggymom]

I have NO out of network benefit at all. I would have to pay for all services out of my own pocket. I have to exhaust all
Physician that are in network and document that they can’t help me. Then I can begin the waiver process. They said even after all of that they can still refuse cover out of network.