Transition of care vs. gap exception vs. OON benefits for an OON surgeon?

Hi, I'm switching from Cigna PPO to Aetna PPO on November 1st in NY. I have a surgery scheduled in mid-January with a neurosurgeon who is out-of-network with all insurance carriers except for Medicare (the pre-auth will have to get restarted on Nov 1st once I join Aetna). I saw this same surgeon in August for an invasive procedure (billed as a surgery) which Cigna approved as OON and billed accordingly — they covered a fair amount, no issues there.

Now that I'm transitioning onto Aetna PPO, I'm unsure if I should be requesting a transition of care for this surgeon since he's OON (even though he was OON on Cigna for me in the past anyway, so I'm not sure if that changes things — or if the TOC would even last long enough til January), or a gap exception to handle this particular upcoming surgery, or if I should just rely on my OON benefits. The surgery is going to be life-saving, so I don't mind if I have to pay a large amount of money, like tens of thousands of dollars, for it to be completed — my main concern is just getting it *approved*. It's a highly specialized surgery that really only a few surgeons in this country can competently perform, so there is a true network deficiency, but I'm not sure I have the time and energy (and/or know-how) to prove that to Aetna. The office I'm working with is also rather disorganized and difficult to get in touch with, so the fewer steps involved, the better, even if that means I end up paying $50,000 more. Thank you.

submitted by /u/JustIntegrateIt
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