Going outside the network means paying more out of pocket, making payment for high-cost procedures exorbitant. If it comes down to fisticuffs with the insurer, line up your allies, starting with your local doctor. If your doctor and the top hospital's specialist agree that you could uniquely benefit from care at the institution, you've got a good team to help argue with your insurer. Even if your local physician balks at helping, or if you're reluctant to ask for your physician's help, you might find a doctor on your own at the hospital of your choice. Most top hospitals have patient referral lines staffed with people who can advise you, help you select a specialist, and brief you on costs.
Hospitals can also help patients begin the negotiations.
Hitting them with the facts. In rare cases, administrators all the way up the institutional hierarchy can get involved in negotiations with an insurer. But more often it's the specialist who helps, by walloping the insurer with the facts. John Wain, surgical director of the lung transplant program at Massachusetts General Hospital, recalls the first time he helped fight for payment for a new procedure, a living lung transplant. But he noted that the patient would not survive without a transplant and gathered reams of research papers indicating that the procedure offered real hope.