[T-3mos] Thoughts on Medical Insurance

As a Silicon Valley Engineer employed with a high tech company, I have been blessed with good medical insurance. Aetna PPO has always been good in taking care of all my bills. Having said that, it can still be tricky navigating through it. Both Dr. Robert Riley and Dr. Kasey Li do not accept any medical insurance. However their office staff is excellent at working with the insurance companies. The hospital and anaesthologist bill have been picked up 100% (thank you Aetna). Over the years I have learnt some do's and dont's and applied it to my MMA.

1. Get a written quote by email from Dr. RR's office. This includes all the procedures including the medical code numbers.
2. Call Aetna to figure out how much of this they will cover. Note that Aetna will pay only what they consider is "reasonable". The difference has to be picked up by you. Also since they are out of network, they will pick up only 70%
3. Aetna does not give what they cover in writing. However they will tell you what it is, so get the name of the person whom you are talking to, also make sure that they make notes in their workbook for all the procedures. I had to talk to 2 people in Aetna to get this right.
   
4. In my case, I tried to convince Aetna to consider Dr. RR and Dr. NP as in-network as an exception. I had to convince them that they were no other local in-network who were qualified for performing MMA. Amazingly Aetna accepted to consider them as in-network. Aetna gave it in writing.
   
5. Back to doctor's office, they talked to Aetna,  and confirmed in writing that the new fee structure was acceptable to them. Total out of pocket expenses for the MMA are $710. Sweet! Carol, the office manager at Dr. RR and Dr. NP's office, says that this is one the best insurances she has ever seen.
   

Moral, communicate with insurance and doctor's office and get as much in writing as possible. I had not done this for one of my earlier procedures and paid dearly!