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@unclegweedoe With the HMO plans, you are restricted to the doctors in the network. You will almost always have to see your Primary Care doctor before you can see any kind of specialist. For instance if you have a strange lesion on your face, you can't go to a dermatologist, you have to first...

@unclegweedoe There's a video with some explanation about PPO here: https://www.bu.edu/hr/health-wellness/health/blue-cross-blue-shield-ppo/ There's a discussion of Blue Care Elect PPO here: https://www.boston.gov/sites/default/files/file/2021/11/BCBS%20PPO%20Member%20Education_0.pdf

@unclegweedoe Do you have a couple of current doctors that you like? You could call the office (during a non-busy hour like maybe 2:30pm) and ask the accounting rep which of the plans they accept or what they recommend/have good history with.

@wings777 You can also appeal the decision with UHC. Do you know why the oral surgeon thinks that this is medically necessary ? Are all 4 wisdom teeth impacted? Were they causing you any pain?

@wings777 Feel free to call the oral surgeons office and ask them for advice. They might just need to send a letter stating that it is medically necessary.

@av3nger It could be fraud if previously they were letting the patient pay an "in network" price for the out-of-network service. At the new office they probably dont' want to do that anymore.