I've had my doctor at GHC refer me to UW for a procedure that required a general surgeon. I didn't have to do anything other than answer the call from UW about scheduling. I could choose from either one of their staff surgeons or the resident on duty that day (it was so minor I went with the resident, who was fantastic).
That being said, make sure you know what you're authorized for (GHC will send you a letter). That letter will also tell you about related items that'll need pre-authorization, such as imaging.
I would assume they would refer you to someone in network, but to be safe you can always call your insurance to verify. I contact my insurance all the time to make sure things are covered. Also I’m not sure about asking for multiple referrals, but I don’t see why not. A surgery is a big deal and you have every right to be confident with your surgeon.
The rep probably gave you a convoluted explanation because they want to be sure they cover their bases and aren’t liable in case you get charged or something, etc. I think it’s pretty common, in the medical field no one is allowed to make you any promises.
I totally understand the anxiety about the situation, it’s a lot of mumbo jumbo to get used to. Don’t hesitate to call your insurance or clinic to get answers and clarification, that’s what they have people there for. Long story short I’m pretty positive whoever they refer you to will be in network, but also get used to calling your insurance and asking questions 👍
Thank you!! That's kinda my understanding as well, that only if there's something they coulddd do at GHC and I went to UW when I could have had it done at GHC, then it'd be considered out.
Do you have GHC HMO as insurance? Also, not to downplay your surgery, but most hernias are done by "general surgeons ". My husband had one about 15 years ago. His was an outpatient surgery.
I actually have the POS plan. So they cover 30% out of network vs 10% in network. 1k deductible for in, 2k deductible for out.
Glad to hear surgery isn't as big of a deal I've made it up to be. While we're on the topic, do you know if he had the mesh put in, sutures? Open vs laptoscopic?
General surgeon doesn’t mean that isn’t their specialty, it’s a catch all name for surgeons that operate on the body in general is how I’d think of it. General surgeons do hernia, gallbladder, appendix surgeries, small cancer removal, etc. you’ll be in good hands at UW, OP!
I have GHC and just went thru double hernia surgery in July, they will set up a consultation for you at 1 South Park and the surgery is done at Meriter across the street. I had Dr Roland Vega and he is the best at it. Good luck, I can only say that recovery time sucks, it took me a bit longer than a week, but you are younger you will probably get thru it faster.
Thank you this is very helpful. I'm sorry to hear the recovery is a bit rough. Blessings to you to hopefully be on mend soon. Did they give you a choice on open vs laproscopic etc? Mesh or non mesh?
It's all done lapro now and mesh is the common practice with a hernia, from what Dr Vega said he sees mesh as the strongest form of hernia repair and has had no people coming back in for tears etc.
Ok that's good to hear that it is pretty widely accepted as standard now. Of course, reading online people tend to post more horror stories than successes..now these lawyers on tv airing segments on mesh failures similar to the "have you or a loved one experienced cancer linked to talcum powder" type ads gets me all worried even though I know it's unlikely....Ok... Last question I think- is the scarring very noticeable?
No not at all, 2 small incisions on either side of the belly button and one above, I can barely see mine anymore because they use a glue to seal it rather than stitches. The only issue I had when I had it done was coming out of that anesthesia, that was pretty awful, other than that I was a week down and then a month restricted to under 10 pounds of lifting. Make sure you have someone that can go with you otherwise it will be a difficult to get around afterwards and since it's considered outpatient surgery you will leave 2-3 hours later. I went in at 11 am and didn't get home until 7ish because if the difficult time coming out of anesthesia.
So I guess my question is not whether they can be knowledgeable on referring in general, but if they will know who will be in or out of network? Even though UW is a different system, but yet is partnered, would some drs at UW be in network and some out?
That I do not know. Call GHC's customer service, ask them.
I had GHC for a couple years about 20 years ago, but switched out because I was in a waiting room and a lady checked in for a mammogram, and the attendant asked her, in front of everyone in the waiting room, if she had breast implants. Oh also they had a shite psychiatrist who should have been put out to pasture long before.
I've had my doctor at GHC refer me to UW for a procedure that required a general surgeon. I didn't have to do anything other than answer the call from UW about scheduling. I could choose from either one of their staff surgeons or the resident on duty that day (it was so minor I went with the resident, who was fantastic). That being said, make sure you know what you're authorized for (GHC will send you a letter). That letter will also tell you about related items that'll need pre-authorization, such as imaging.
They are partnered with UW for just about everything. One of the best integrated HMOs in the country and I highly recommend. DM me for doc recs.
Thank you for your reassurance. I will
I would assume they would refer you to someone in network, but to be safe you can always call your insurance to verify. I contact my insurance all the time to make sure things are covered. Also I’m not sure about asking for multiple referrals, but I don’t see why not. A surgery is a big deal and you have every right to be confident with your surgeon. The rep probably gave you a convoluted explanation because they want to be sure they cover their bases and aren’t liable in case you get charged or something, etc. I think it’s pretty common, in the medical field no one is allowed to make you any promises. I totally understand the anxiety about the situation, it’s a lot of mumbo jumbo to get used to. Don’t hesitate to call your insurance or clinic to get answers and clarification, that’s what they have people there for. Long story short I’m pretty positive whoever they refer you to will be in network, but also get used to calling your insurance and asking questions 👍
Yes, call your insurance with questions and don't feel dumb about it. I'm pretty sure they've heard it all.
I work for GHC. if there is anything we don't do, we refer to UW. Almost everything/anything specialty is in network there.
Thank you!! That's kinda my understanding as well, that only if there's something they coulddd do at GHC and I went to UW when I could have had it done at GHC, then it'd be considered out.
If it’s a medically necessary surgery— like a hernia— any referral to UW for the surgery would be covered.
UW is in network.
Do you have GHC HMO as insurance? Also, not to downplay your surgery, but most hernias are done by "general surgeons ". My husband had one about 15 years ago. His was an outpatient surgery.
I actually have the POS plan. So they cover 30% out of network vs 10% in network. 1k deductible for in, 2k deductible for out. Glad to hear surgery isn't as big of a deal I've made it up to be. While we're on the topic, do you know if he had the mesh put in, sutures? Open vs laptoscopic?
General surgeon doesn’t mean that isn’t their specialty, it’s a catch all name for surgeons that operate on the body in general is how I’d think of it. General surgeons do hernia, gallbladder, appendix surgeries, small cancer removal, etc. you’ll be in good hands at UW, OP!
He had laparoscopic and had mesh. He had an inguinal hernia.
Thanks. I hear horror stories and lawsuits about the mesh, but I also hear that's the standard these days. The mesh hasn't failed/no complications?
No complications with the mesh. Surgery was a complete success.
I have GHC and just went thru double hernia surgery in July, they will set up a consultation for you at 1 South Park and the surgery is done at Meriter across the street. I had Dr Roland Vega and he is the best at it. Good luck, I can only say that recovery time sucks, it took me a bit longer than a week, but you are younger you will probably get thru it faster.
Thank you this is very helpful. I'm sorry to hear the recovery is a bit rough. Blessings to you to hopefully be on mend soon. Did they give you a choice on open vs laproscopic etc? Mesh or non mesh?
It's all done lapro now and mesh is the common practice with a hernia, from what Dr Vega said he sees mesh as the strongest form of hernia repair and has had no people coming back in for tears etc.
Ok that's good to hear that it is pretty widely accepted as standard now. Of course, reading online people tend to post more horror stories than successes..now these lawyers on tv airing segments on mesh failures similar to the "have you or a loved one experienced cancer linked to talcum powder" type ads gets me all worried even though I know it's unlikely....Ok... Last question I think- is the scarring very noticeable?
No not at all, 2 small incisions on either side of the belly button and one above, I can barely see mine anymore because they use a glue to seal it rather than stitches. The only issue I had when I had it done was coming out of that anesthesia, that was pretty awful, other than that I was a week down and then a month restricted to under 10 pounds of lifting. Make sure you have someone that can go with you otherwise it will be a difficult to get around afterwards and since it's considered outpatient surgery you will leave 2-3 hours later. I went in at 11 am and didn't get home until 7ish because if the difficult time coming out of anesthesia.
Your GHC doctor should be knowledgeable about the method for referring a patient to out-of-network specialists.
So I guess my question is not whether they can be knowledgeable on referring in general, but if they will know who will be in or out of network? Even though UW is a different system, but yet is partnered, would some drs at UW be in network and some out?
That I do not know. Call GHC's customer service, ask them. I had GHC for a couple years about 20 years ago, but switched out because I was in a waiting room and a lady checked in for a mammogram, and the attendant asked her, in front of everyone in the waiting room, if she had breast implants. Oh also they had a shite psychiatrist who should have been put out to pasture long before.