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Thread: HMO insurance..

  1. #1
    Join Date
    Jan 2006
    Posts
    5

    HMO insurance..

    I am running up on the "can't refer outside the local IPO within the HMO", Though the more prominant bay area specialists in scoliosis docs are in my insurance plan..I live in a small local community and none of the docs have much experience in scoliosis..scares me to think that someone not familiar or an expert rather operating on me..Anyone know if switching to a PPO still keeps you in the local network?? I have Blue Cross CAlif care HMO at the moment, but can switch to PPO
    Thanks, Kimbo
    I've already been told I can't be refered out of the area!!What can I do??

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,333
    Kimbo...

    With Blue Cross PPO insurance, you can choose to see anyone, anywhere, as long as they accept Blue Cross insurance.

    To whom are they currently referring you?

    --Linda

  3. #3
    Join Date
    Dec 2005
    Location
    new jersey
    Posts
    850
    kim,
    I'm finding out as I research more. I always knew ppo was better to have than a hmo but never had a big operation like this one will be. I've been told to make sure to have a ppo plan for surgery. When I went to my first appmt to a scoliosis specialist, they told me on the phone they did'nt participate in any plans... that made me a bit nervous. Later I found out that none of these specialists do. They are out of network & it does'nt mean your ins. won't pick it up--just chge your plan when you are able & go by what your specialist's ins. person suggests....ask--they will work w/ you. Most of us that are healthy, don't ever really research their plans until a big operation like this....Lynne

  4. #4
    Join Date
    Jan 2006
    Posts
    5

    Referred..

    In HMO I am currently being referred to my choice of 4 other docs in my small county of Santa Cruz CA area.
    I had a previous consult appt last year with Dr. Christopher Summa from the Spine center of Aptos..a really small town..he seemed to be familiar, but I did not ask him how many he has performed..He was maybe 35..so not many likely..most of his cases are other spinal ailments no doubt..I think adult scoliosis is a very specialized field..
    Thanks for the responses!

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,333
    Hi...

    I know most of the Bay Area scoliosis doctors, and have never heard of Dr. Summa, so I think you're wise to wait. When you get your PPO insurance, do you know who you want to see?

    --Linda

  6. #6
    Join Date
    Jan 2006
    Posts
    5

    Doc..

    Hello Linda..
    Yes, I wanted to be referred to Dr. David Bradford from UCSF..I contacted him via email last year and said though he does not do many surgeries himelf anymore , he would be happy to see me and possibly consult with some of his colleagues.., maybe I will pay for a consult myself, though expensive no doubt, but at least I'll get another view/..
    Thanks..

  7. #7
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,333
    Hi...

    Dr. Bradford isn't doing surgery any longer. However, Serena Hu, Sigurd Berven, and Vedat Deviren all do a lot of spinal deformity surgery, so you'll be in good hands up there.

    You might want to appeal to your HMO to send you out of network since Dr. Summa probably does so few of these surgeries. It's worth a shot anyway.

    Regards,
    Linda

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