So this is a crazy case where my client had difficulty with pregnancy. She needed surgery and she found the gynecologist that was out of network. The gynecologist told my client that even though he was out of network, he would come in to do the surgery after the first surgeon made the incision.
The first surgeon was in network, but the second surgeon, who was really doing the total operation, he was out of network. My client had an HMO policy. The second surgeon was denied for reimbursement and the first surgeon the HMO provider was paid.
So after my client had the surgery, the second surgeon requested money from the first surgeon since he was not part of the HMO, and he was then reimbursed a portion of the money paid to the first surgeon.
So look, if you have an HMO, it’s best to get an HMO provider to do whatever sometimes you’re looking for a specialist and you might have someone out of network. Hopefully nothing like this will ever happen to you, but please if you need any help call me, my name is Adria Gross. I’m the owner of Medwise Insurance Advocacy.