Re: BCBS Fed. E'ees Pays 75% of Allowable Charge

[Guest guest]

Holly:

That is good news, but I can understand you wanting the full amt

covered! It is common for insurance companies to cover what they

call " reasonable & customary " amount. That means they set a dollar

amount of what they consider to be " reasonable & customary " and that

is the amt they will cover, no matter what the provider charges. My

dental plan is like this & my prior health ins. was as well. I

totally disagree with it, where do they get off deciding what

reasonable & customary is??? They say that they don't set the amt,

that they get this amount from an average of what providers charge in

the area I think. It really drives me crazy. The provider's charge

is always more than the ins. company's r & c amount is. My opinion

is it's just another way for ins. companies not to pay all they

should. Wow, I'm sounding quite bitter this morning! Sorry!

It is great news though that they'll cover some, it's better than

nothing for sure!!!

How is little doing in his band?? Hope all is well.

Debbie abby's mom DOCGrad

MI

> After already paying $1200 of the $3000 Doc-Band charge ourselves,

DH

> got aggravated and called BCBS Federal Employees Program (our

health

> insurer) to find out the status of our claim. He was told over the

> telephone that our insurance will pay 75% of the " allowable charge "

> for the band and treatment, which is $2080. In short, BCBS will

pay

> approx. $1500 (75% of $2080), and we'll have to pay the other half

> (which we've basically already paid anyway). I guess this is good

> news that our claim was not denied?? It would be nice if they paid

> 100%, or even 75% of the Doc-Band charge, as opposed to 75% of a

> lesser, " allowable " charge. Anyone else had this same result?

>

> Holly &

[Guest guest]

Holly,

As rotten as it is, I think its fairly common for insurance companies

to set a limit on how much they are going to pay, and then actually

only pay a percentage of that amount. I'm glad to hear that they are

going to cover some of the cost of the band; even if it isn't the

full amount, its still better than nothing...if thats any consolation!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> After already paying $1200 of the $3000 Doc-Band charge ourselves,

DH

> got aggravated and called BCBS Federal Employees Program (our

health

> insurer) to find out the status of our claim. He was told over the

> telephone that our insurance will pay 75% of the " allowable charge "

> for the band and treatment, which is $2080. In short, BCBS will

pay

> approx. $1500 (75% of $2080), and we'll have to pay the other half

> (which we've basically already paid anyway). I guess this is good

> news that our claim was not denied?? It would be nice if they paid

> 100%, or even 75% of the Doc-Band charge, as opposed to 75% of a

> lesser, " allowable " charge. Anyone else had this same result?

>

> Holly &