insurance advice

  • On September 24, 2012
Hi,
I’m a former patient of Dr. Mussalli and Dr. Worth who had a healthy baby girl with them on 11/27/11.  I am in a PPO-only insurance plan, but I was able to obtain a waiver so that a large part of the cost (about half) was covered by insurance.  I just wanted to share with you how I did it in case it’s helpful for future patients (and for Dr. Mussalli and Worth).
I was in a PPO-only BlueCross BlueShield plan.  The plan had an exception where you could obtain a waiver for services performed by an out-of-network doctor if they were unique services that could not be obtained by an in-network doctor.  This wasn’t covered in the plan materials, but I learned about it from speaking to representatives of BlueCross BlueShield.
I argued that “minimally invasive obstetrics” was a service that could not be easily obtained by an in-network doctor and cited the specific of skill with forceps, skill in administering non-epidural pain relief, and significant experience with natural childbirth.  They accepted this argument.  It also helped that I found a helpful person at Bluecross Blueshield to speak with and told her I would send a letter to her employer commending her client service 🙂
I hope this is helpful for anyone who was in my situation and who may be on the fence about switching to Dr. Mussalli and Dr. Worth.  I was very lucky to be able to switch to them when I did.  It was one of the best decisions I’ve ever made.  I’ve attached a few pictures of my daughter, who just turned 9 months a few weeks ago. 
All the best,
A

3 Comments

missmimichi
  • Apr 22 2013
What kind of documentation did you need to give?
Village Obstetrics™
  • Apr 7 2014
Not a documentation but a specific situation like VBAC or high risk pregnancy, etc.
George Puzo
  • May 14 2014
I could not agree with you more Miss Mimi on the importance of having the proper documentation. I always check with the clinic prior to my appointment on what documentation I will need to provide. I wonder though what specific documentation my wife will need to take to her obstetrics.

George Puzo | http://www.desertroseobgynaz.com/services.html