# Insurance issues **URL:** \ **Category:** General\ **Tags:** treatment\ **Created:** [October 18, 2025, 1:01am UTC](https://forum.livingwitheagle.org/t/insurance-issues/20914 "2025-10-18T01:01:23Z")\ **Posts on this page:** 1\ **Showing post:** 2
**Author:** ![Isaiah\_40\_31](https://yyz1.discourse-cdn.com/flex027/user_avatar/forum.livingwitheagle.org/isaiah_40_31/32/3054_2.png) [@Isaiah\_40\_31](https://forum.livingwitheagle.org/u/Isaiah_40_31)\ **Post date:** [October 18, 2025, 5:22am UTC](https://forum.livingwitheagle.org/t/insurance-issues/20914/2 "2025-10-18T05:22:48Z")
@DUnreal - We’ve had a number of members who’ve had the same situation you’re in w/ insurance that won’t pay for out of state doctors’ visits/surgeries. Some insurance companies employ a patient advocate who will go to bat for you w/ the insurance company. If yours doesn’t have someone like that, then there are patient advocates who work independently & can help you appeal the need for specialized surgery since there are no doctors in your state who are capable of doing the surgery you need. Another option is to contact your insurance company & ask what their appeals process is then do what they request. This doesn’t always provide a positive result. We had one member who threatened to file a complaint w/ the medical insurance board in his state if his insurance didn’t approve his out of state ES surgery. He got the approval he needed after he proposed that to them as his next step. Here are 3 cases to help you get started. > [@Finally won the insurance battle](https://forum.livingwitheagle.org/t/finally-won-the-insurance-battle/19842): > > Hi friends. A year post my first surgery and Blue Shield of CA has finally paid my surgical claims from both surgeries! After a long battle they finally retroactively authorized the surgeries but then the fun and games really began. First they reprocessed the original claims and then once again denied them. Then they had me have Banner Health submit new claims and they denied those as well…even with the authorization in place. It was a game of procedure codes that I could never win because Blue … > [@Update ....final appeal](https://forum.livingwitheagle.org/t/update-final-appeal/15203): > > Geeze- it’s been jumping though one hoop after next, doing everything my insurance wants me to. I am in my final external appeal trying to get my surgery when low and behold Jules from Dr. Costantino’s office calls me to tell me that insurance overturned their decision! I was in a little shock and don’t think it sunk in. I was telling him that I just spoke with my advocate a few hours prior- and then the other line beeps in it was my insurance. I told Jules I’d call him back. My advocate confirm… > [@Dr Osborne- Blue Cross Blue Shield Out of Network Waiver-2025](https://forum.livingwitheagle.org/t/dr-osborne-blue-cross-blue-shield-out-of-network-waiver-2025/19658/32): > > You are not alone. You may need to get stern, how can it be deemed exploratory when there are “specialist” treating this and when its been covered for other members. Most of the time its calling and speaking to the right person. I know your struggle, thank you for updating us and please keep us posted. --- _[View the full topic](https://forum.livingwitheagle.org/t/insurance-issues/20914)._