ANA Discussion Forum
General Category => Insurance => Topic started by: Dantheman on January 23, 2007, 12:37:58 pm
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Just curious, how many folks had an HMO for insurance, and did they cover all of the surgery or did you owe the Dr.'s some money at the end?
I have an HMO, live on the southern tier of NYS and am a little concerned about debt.
Dan
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Hi Dan,
I have BC/BS of MA PPO, so I cannot answer your question. Does your HMO provide a customer service dept that you can inquire about what is covered and what facilities they do cover? If you decide to go out of your plan, they should be able to help you determine just how much will be out-of-pocket. I know many treating facilities will talk directly to medical coverage providers as well.
I know there are a few folks here with extensive insurance expertise so I'm hoping they chime in to help guide you better than I can.
Phyl
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Exactly Phyl,
Check with your customer service - the phone # should be on the back of your ins. card.
And the facility in network should help out with checking with the HMO re: coverage.
Personally, I can't imagine an HMO not covering this serious surgery !!!
Best Wishes, Nancy
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Bruce,
When was the HMO contract for your coverage renewed? If it was recently, that may be why the "pre-existing" claus no longer is there... just a thought. I've run into it before as well at time of contract renewal.
Phyl
I just called my HMO (BC/BS) today, and they cover everything except for the deductibles. The strange thing though is that in the literature it stated that there was a pre-existing condition clause, yet today they tell me that they have no such clause so that I could have been treated months ago. I guess it really is worth giving your insurance company a call first to get the particulars.
Bruce
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I'll be in contact with the HMO (CDPHP) soon. I have my final appointment with my Otologist next week. All my testing was completed last week. I hope to get a surgery date soon.
My HMO doesn't have Otologists nor Neurosurgeons in network...that's the thing. Deductables don't worry me. It's all of the paperwork the Dr's have you sign that state you will pay what the insurance won't cover. That's what worries me.
So far, CDPHP has been great...
Dan
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Give the HMO a call Dan,
this is serious surgery - you deserve the best
(how can the HMO not have neurosurgeons in network ???)
Good luck with everything, Nancy
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Hi,
We had a HMO. We had our surgery at House clinic and that was out of network, but House clinic did negotiate with insurance company and we did not have to pay anything.
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Dan, I have an HMO and live in MO. I had docs here but, after lots of research, wanted to go to HOUSE. After my second appeal and assistance from the state of MO(I filed a complaint with the state against my insurance company) I got the out of network approved.
If there are none in your network they will probably find you a doctor that is capable of performing the surgery, however, you want someone highly skilled and have a right to the best care you can get. Do your research because the doc they pick may not be the one you want as was in my case.
Best wishes.
Amy
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Addendum to first reply- my bills were covered, I had to pay only deductibles, it was as if I had gone in network.
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I have Cigna HMO and so far have not had to deal with the insurance company directly. I did ask my Otologist's assistant and she replied she would take care of all the approvals and authorizations I would need. This has been a great weight lifted off my shoulders.
I know for my doctor's visit I have a $15.00 co-pay but that is about it.
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I spoke to CDPHP today and they said I just have to pay the hospitalization copay of $100 a day for 5 days. That's it. Hopefully that's how it will all play out. Thanks for everyones replies and support!
Dan
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Dan, $500 (give or take) for all that will be done... works for me... and hoping this takes a monkey off your back so you don't have to worry, from a financial standpoint. Glad it is working out for you.
Phyl
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Hi Bruce,
I remember when you moved and that you mentioned the pre-existing condition clause. Christopher's had HealthAmerica and it was very good but recently (Jan 1) they switched to BC/BS of PA. I frantically searched for that clause. I couldn't find it. I called them and but they didn't have information on his benefits yet. I'm still worried that they will reject his Feb. MRI. I'm really worried. He now has the state Access to backup the BC/BS.
Before AN, he had a full-time job and was a part-time college student and fortunately he had this insurance. After AN removal, I got him on the state HIPP program where they pay the employer for his health insurance (because it is more cost effective). Anyway, now they claim they will pay whatever his private insurance doesn't pay. I sure hope they do because we had a $4,000 rehab bill and it is bound to get larger and that Feb. MRI coming up.
Let us know how your BC/BS is working...I've been following you.
Rita
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AHH Insurance- my Blue Shield is vague about the whole MRI/CT Scan thang- turns out I use the MRI expense to fulfill my deductible.... nevermind that it is medically necessary... ::) Annie
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I have an HMO (Healthnet) and I even got authorization to have the surgery at a hospital other than the one that I had signed up for. So far I have not received any bills BUT, I just received in the mail from the hospital that my HMO had under paid the contract that the two had agreed on. The letter also stated that if it does not get resolved then I would be responsible for the difference. I am anticipating that this will get resolved and if not then possibly litigation ??? Supposedly patients with HMO's are not suppose to be bothered with things like this. Just when everything seems to be going good something has to go wrong. :(
As long as authorizations are obtained everything should be fine. Times like these we find out what are insurances are really made of; do they work when we need them or are they just taking our money.
jenn
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Hi Dan - I wish I had seen your post earlier (I am from WNY), BC/BS was great, some co-pays but what I expected. Hope you are recovering well at this point!!
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My surgery was on January 12th and I also had the BAHA attachment point implanted. The actual sound processor will probably not be attached until May.
My insurer is a PPO and I have received their letters, questioning pre-existing conditions and telling me that I was not eligible for coverage. In each case, I called the customer service number on the back of my insurance card, with good results. Make sure that you write down the date you called and the name of the person who talked to you. In each case, I was able to talk through the problem and receive assurance that I was eligible for insurance coverage and that they would correct their records.
After researching the on-line medical insurance contract on my office PC, I learned that sound processors were not included in the plan, but that was for 2006. Things could have changed in the 2007 contract and I am prepared to dial that customer service number as soon as I see a declination of coverage for the BAHA in any statement of benefits that is mailed to me. If this AN has taught me anything, it is to be patient and never give up hope. Hang in there!
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I had an HMO and they denied my plea to go to the doctors that I wanted to go to. So they gave me a list of five doctors that i could go to. Lucky fo rme, the agent did not do what she was supposed to do and she just gave me the first fiev doctors off of a list. I found out later that they are supposed to actually research what the procedure entails. So they gave me a list of ENT's in family practices and one surgeon. I went to all of their doctors, listened to them, and for all of them except the surgeon I asked to write me a letter stating that they cannot perform the procedure. I also got a letter from my primary (which was basically my letter rubber stamped) and a letter from the doctors that I wanted to go with. Well after a long headache, it worked! My HMO decided to let these doctors be considered "in network" for the dates of the surgery. Good for me, good for my wallet.
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I have BC HMO (California Care). The question I have is that if I'm opted for a surgery, can I pick the doctors to perform it or they assign them to me?
Naturally I'd like to have the best doctors to do the operation.
Of course I will call BC and ask but usually if I know the options and ways to talk the them ahead of time it would help. I'm pretty new to this so any detailed information would be very much appreciated.
Thanks.
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My insurance is BC/BS Hawaii (a PPO). My issue is that they have denied payment for several items on the House Clinic billing and have asked House to provide more information. I'm hopeful that House and the PPO can work it out, otherwise I'm liable for $18,500 worth of service.... yikes....