Re: Does PPO cover Spect scanning?

[Guest guest]

I spoke with Dr. Uszler's office about this last year and he told me

I could have it done wherever my insurance covered it and have them

send the raw data (not films, just the disc) to him for review. It

would then only cost his consultation fee which I think was $450.

Cheryl

~ http://www.gryffins-tail.blogspot.com ~

On Apr 5, 2009, at 5:49 PM, Shenko wrote:

>

> Any recommendations to qualified Autism Spect scanning close to the

> Illinois area?

> Is there alternate sources that may help or fund this process for

> my son?

>

> Any info whatsoever will help,

>

>

>

>

> ------------------------------------

>

> Responsibility for the content of this message lies strictly with

> the original author(s), and is not necessarily endorsed by or the

> opinion of the Research Institute, the Parent Coalition,

> or the list moderator(s).

>

[Guest guest]

Our son's spect scan was covered by our BCBS PPO policy. Just check to make sure

you're getting it done by a preferred provider. You may want to get it

preapproved by your insurance company.

All the best,

Robyn

> From: Shenko <jankevus@...>

> Subject: Does PPO cover Spect scanning?

> nids

> Date: Sunday, April 5, 2009, 5:49 PM

> Any recommendations to qualified Autism Spect scanning close

> to the Illinois area?

> Is there alternate sources that may help or fund this

> process for my son?

>

> Any info whatsoever will help,

>

>

[Guest guest]

Santa Imaging made me file my Spect claim to BCBS federal. The insurance

paid about $1200 on a $1700 bill.  That does not include putting him down, which

was $750.   

 

-- On Mon, 4/6/09, Robyn & Greg Coggins <rngcoggs@...> wrote:

From: Robyn & Greg Coggins <rngcoggs@...>

Subject: Re: Does PPO cover Spect scanning?

Date: Monday, April 6, 2009, 11:00 AM

Our son's spect scan was covered by our BCBS PPO policy. Just check to make sure

you're getting it done by a preferred provider. You may want to get it

preapproved by your insurance company.

All the best,

Robyn

> From: Shenko <jankevus (DOT) com>

> Subject: Does PPO cover Spect scanning?

> nidsgroups (DOT) com

> Date: Sunday, April 5, 2009, 5:49 PM

> Any recommendations to qualified Autism Spect scanning close

> to the Illinois area?

> Is there alternate sources that may help or fund this

> process for my son?

>

> Any info whatsoever will help,

>

>

[Guest guest]

We have the same plan, but were told my SMIT that they probably wouldn't pay

and we had to pay upfront. BCBS wasn't happy. Insurance paid about $980--their

agreement with SMIT--and we had to go after SMIT for the rest. Check to see of

SMIT is a preferred provider on your plan. If they are, don't pay upfront like

we did. Let them bill insurance.

HTH,

Robyn

>

> > From: Shenko <jankevus (DOT) com>

> > Subject: Does PPO cover Spect scanning?

> > nidsgroups (DOT) com

> > Date: Sunday, April 5, 2009, 5:49 PM

> > Any recommendations to qualified Autism Spect scanning

> close

> > to the Illinois area?

> > Is there alternate sources that may help or fund this

> > process for my son?

> >

> > Any info whatsoever will help,

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[Guest guest]

I did pay upfront.  They are a preferred provider with BCBS Federal.  How much

of a hassle will it be for them to credit my account for the difference?      

>

> > From: Shenko <jankevus (DOT) com>

> > Subject: Does PPO cover Spect scanning?

> > nidsgroups (DOT) com

> > Date: Sunday, April 5, 2009, 5:49 PM

> > Any recommendations to qualified Autism Spect scanning

> close

> > to the Illinois area?

> > Is there alternate sources that may help or fund this

> > process for my son?

> >

> > Any info whatsoever will help,

> >

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[Guest guest]

You will want to confirm this with BC Federal ... If a provider is 'preferred',

then they are contracted with BC to take a write off of the difference between

what they 'charge' for a procedure and what BC 'allows' for a procedure.  BC

will tell you how much your out-of-pocket is, and the difference should be a

write off.

The company should refund your account within 30 days of you requesting it,

although that isn't a firm required policy - just good business.  Surely they

already have a system set up for that since they collect up front.

Just make sure that you are not paying more than what BC shows is your

out-of-pocket ... but you would verify with your BC rep whether or not they are

required to write off that difference or not.  It depends on their network

status with BC.

HTH-

________________________________

From: FREDA CURL <fredacurl@...>

Sent: Wednesday, April 8, 2009 6:57:44 PM

Subject: Re: Does PPO cover Spect scanning?

I did pay upfront.  They are a preferred provider with BCBS Federal.  How much

of a hassle will it be for them to credit my account for the difference?      

>

> > From: Shenko <jankevus (DOT) com>

> > Subject: Does PPO cover Spect scanning?

> > nidsgroups (DOT) com

> > Date: Sunday, April 5, 2009, 5:49 PM

> > Any recommendations to qualified Autism Spect scanning

> close

> > to the Illinois area?

> > Is there alternate sources that may help or fund this

> > process for my son?

> >

> > Any info whatsoever will help,

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[Guest guest]

A total hassle. Because SMIT is a preferred provider, they agree to provide

services to BCBS insured at a predetermined rate. If you pay them upfront, you

are charged the full rate. BCBS will only reimburse you for the predetermined

rate. We were reimbursed by BCBS but only for a fraction of the total cost. It

took many, many phone calls and letters to BCBS and to SMIT (and BCBS calling

SMIT) and finally SMIT reimbursed us for the rest. In the end, our copay was

only about $150.

HTH,

Robyn

> >

> > > From: Shenko <jankevus (DOT) com>

> > > Subject: Does PPO cover Spect scanning?

> > > nidsgroups (DOT) com

> > > Date: Sunday, April 5, 2009, 5:49 PM

> > > Any recommendations to qualified Autism Spect

> scanning

> > close

> > > to the Illinois area?

> > > Is there alternate sources that may help or fund

> this

> > > process for my son?

> > >

> > > Any info whatsoever will help,

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[Guest guest]

Again, you may want to confirm that w/BC too - whether or not you waive the

right to the pre-determined rate (their fee schedule or 'allowable') when you

pay up front, or whether they are still supposed to take that write off once a

claim is approved.  I think that they cannot be under contract w/BC and collect

more from you simply by getting it " up front " - they would be breaking their

contract w/BC if they are 'preferred providers', and BC doesn't like that.  They

can't choose both - being a provider, and then forcing people to pay in full. 

Did BC pay directly to you?  Don't take the facility's word for it.  People can

misunderstand the guidelines, because w/other commercial policies, you are

perfectly within your rights to do it that way, but not w/some insurances like

BC, Medicare, etc.

HTH-

Let me know if you get that money back.

________________________________

From: Robyn & Greg Coggins <rngcoggs@...>

Sent: Thursday, April 9, 2009 11:19:54 AM

Subject: Re: Does PPO cover Spect scanning?

A total hassle. Because SMIT is a preferred provider, they agree to provide

services to BCBS insured at a predetermined rate. If you pay them upfront, you

are charged the full rate. BCBS will only reimburse you for the predetermined

rate. We were reimbursed by BCBS but only for a fraction of the total cost. It

took many, many phone calls and letters to BCBS and to SMIT (and BCBS calling

SMIT) and finally SMIT reimbursed us for the rest. In the end, our copay was

only about $150.

HTH,

Robyn

> >

> > > From: Shenko <jankevus (DOT) com>

> > > Subject: Does PPO cover Spect scanning?

> > > nidsgroups (DOT) com

> > > Date: Sunday, April 5, 2009, 5:49 PM

> > > Any recommendations to qualified Autism Spect

> scanning

> > close

> > > to the Illinois area?

> > > Is there alternate sources that may help or fund

> this

> > > process for my son?

> > >

> > > Any info whatsoever will help,

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[Guest guest]

BC ferderal paid the money directly to me.  I spoke with the Dr.'s office and it

was turned in to their accountant and for me to call back on Monday.  BC

federal told me that they should pay me the difference back within 30 days. BC

federal did not mention to me about giving up any rights since I paid up front. 

> >

> > > From: Shenko <jankevus (DOT) com>

> > > Subject: Does PPO cover Spect scanning?

> > > nidsgroups (DOT) com

> > > Date: Sunday, April 5, 2009, 5:49 PM

> > > Any recommendations to qualified Autism Spect

> scanning

> > close

> > > to the Illinois area?

> > > Is there alternate sources that may help or fund

> this

> > > process for my son?

> > >

> > > Any info whatsoever will help,

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[Guest guest]

Say it is not so.  About how long did it take you to get your money back? 

With BC federal, I do not have a deductible if I use their preferred providers. 

 BC ferderal told me to give them about 30 days to refund me. 

I am supposed to call SMIT back on Monday, about my refund.  Their Accountant is

researching it. Probably just to buy them more time.       

> >

> > > From: Shenko <jankevus (DOT) com>

> > > Subject: Does PPO cover Spect scanning?

> > > nidsgroups (DOT) com

> > > Date: Sunday, April 5, 2009, 5:49 PM

> > > Any recommendations to qualified Autism Spect

> scanning

> > close

> > > to the Illinois area?

> > > Is there alternate sources that may help or fund

> this

> > > process for my son?

> > >

> > > Any info whatsoever will help,

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[Guest guest]

It took lots of phone calls and a couple of letters. BCBS got involved because

preferred providers are not supposed to take payment up front. They're supposed

to bill insurance. If there's a copay, you would probably have to pay that up

front.

In the letter we gave them 30 days to respond or we would file a complaint with

BCBS, CA Dept of Insurance, etc. We had our money in 30 days.

I hope this helps.

Robyn

> > >

> > > > From: Shenko <jankevus (DOT)

> com>

> > > > Subject: Does PPO cover Spect

> scanning?

> > > > nidsgroups (DOT) com

> > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > Any recommendations to qualified Autism

> Spect

> > scanning

> > > close

> > > > to the Illinois area?

> > > > Is there alternate sources that may help or

> fund

> > this

> > > > process for my son?

> > > >

> > > > Any info whatsoever will help,

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[Guest guest]

,

You are correct. By asking for money up front, they are risking breaking their

contract with BCBS (which is part of the leverage we used to get our refund).

Bottom line: if someone is a preferred provider, you pay only the necessary

copay and no more until you get your EOB. If you do pay up front, you're not

giving up any rights to get your money back, it's just harder to get it back

once it's gone.

All the best,

Robyn

> > >

> > > > From: Shenko <jankevus (DOT)

> com>

> > > > Subject: Does PPO cover Spect

> scanning?

> > > > nidsgroups (DOT) com

> > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > Any recommendations to qualified Autism

> Spect

> > scanning

> > > close

> > > > to the Illinois area?

> > > > Is there alternate sources that may help or

> fund

> > this

> > > > process for my son?

> > > >

> > > > Any info whatsoever will help,

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[Guest guest]

Now I have the same problem with Dr. G's office. 

My insurance will pay for Dr. G consults in his office.  Paid his full asking

price.  However, they denied paying for phone consults.  I sent a letter

explaining that this was necessary since I live in Mississippi.  They agreed,

but they will only allow to pay $35 for a phone consult. This was for a $275

bill. Dr. G is on BCBS list of health care providers, and BCBS says he is

liable for that amount.  I inquired with Dr. G's office and they said that they

would get back with me.  I could tell by the tone that Dr. G would not be happy

about it.  I do not know what to do, but I do not know if I can continue paying

this high fees. 

    

> > >

> > > > From: Shenko <jankevus (DOT)

> com>

> > > > Subject: Does PPO cover Spect

> scanning?

> > > > nidsgroups (DOT) com

> > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > Any recommendations to qualified Autism

> Spect

> > scanning

> > > close

> > > > to the Illinois area?

> > > > Is there alternate sources that may help or

> fund

> > this

> > > > process for my son?

> > > >

> > > > Any info whatsoever will help,

> > > >

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[Guest guest]

I don't know very many health insurance plans that pay for phone consults, but

$35 seems low to me. If they're going to pay, you would think it would be more

than that. The regular rules of reimbursement may not apply since it's a phone

consult. You may want to post this question on the autism insurance

group.

All the best,

Robyn

> > > >

> > > > > From: Shenko <jankevus (DOT)

> > com>

> > > > > Subject: Does PPO cover Spect

> > scanning?

> > > > > nidsgroups (DOT) com

> > > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > > Any recommendations to qualified Autism

> > Spect

> > > scanning

> > > > close

> > > > > to the Illinois area?

> > > > > Is there alternate sources that may

> help or

> > fund

> > > this

> > > > > process for my son?

> > > > >

> > > > > Any info whatsoever will help,

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[Guest guest]

Hey, Freda.

I just checked the FEPBLUE.org site and could find nothing regarding

reimbursement of phone consultations. You may want to find out from customer

service where you can read up on the specific policy regarding phone

consultations.

Please let me know what you find out. Although we live locally, we've talked

about relocating. This would definitely be something we'd need covered

considering 4 out of 5 of us see Dr. G.

Good luck,

Robyn

> > > > >

> > > > > > From: Shenko

> <jankevus (DOT)

> > > com>

> > > > > > Subject: Does PPO cover

> Spect

> > > scanning?

> > > > > > nidsgroups (DOT) com

> > > > > > Date: Sunday, April 5, 2009, 5:49

> PM

> > > > > > Any recommendations to qualified

> Autism

> > > Spect

> > > > scanning

> > > > > close

> > > > > > to the Illinois area?

> > > > > > Is there alternate sources that

> may

> > help or

> > > fund

> > > > this

> > > > > > process for my son?

> > > > > >

> > > > > > Any info whatsoever will help,

> > > > > >

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[Guest guest]

It will actually be $50, I believe.  The insurance will pay $35 and I have a

copay of $15, but that still is low.  I pray that it will be taken care of.   

> > > >

> > > > > From: Shenko <jankevus (DOT)

> > com>

> > > > > Subject: Does PPO cover Spect

> > scanning?

> > > > > nidsgroups (DOT) com

> > > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > > Any recommendations to qualified Autism

> > Spect

> > > scanning

> > > > close

> > > > > to the Illinois area?

> > > > > Is there alternate sources that may

> help or

> > fund

> > > this

> > > > > process for my son?

> > > > >

> > > > > Any info whatsoever will help,

> > > > >

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[Guest guest]

I was told that my check was in the mail by SMIT. 

YES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

> > >

> > > > From: Shenko <jankevus (DOT)

> com>

> > > > Subject: Does PPO cover Spect

> scanning?

> > > > nidsgroups (DOT) com

> > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > Any recommendations to qualified Autism

> Spect

> > scanning

> > > close

> > > > to the Illinois area?

> > > > Is there alternate sources that may help or

> fund

> > this

> > > > process for my son?

> > > >

> > > > Any info whatsoever will help,

> > > >

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[Guest guest]

Great, Freda. I'm happy for you.

All the best,

Robyn

> > > >

> > > > > From: Shenko <jankevus (DOT)

> > com>

> > > > > Subject: Does PPO cover Spect

> > scanning?

> > > > > nidsgroups (DOT) com

> > > > > Date: Sunday, April 5, 2009, 5:49 PM

> > > > > Any recommendations to qualified Autism

> > Spect

> > > scanning

> > > > close

> > > > > to the Illinois area?

> > > > > Is there alternate sources that may

> help or

> > fund

> > > this

> > > > > process for my son?

> > > > >

> > > > > Any info whatsoever will help,

> > > > >

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[Guest guest]

Please keep me updated!

Robyn

> > > > >

> > > > > > From: Shenko

> <jankevus (DOT)

> > > com>

> > > > > > Subject: Does PPO cover

> Spect

> > > scanning?

> > > > > > nidsgroups (DOT) com

> > > > > > Date: Sunday, April 5, 2009, 5:49

> PM

> > > > > > Any recommendations to qualified

> Autism

> > > Spect

> > > > scanning

> > > > > close

> > > > > > to the Illinois area?

> > > > > > Is there alternate sources that

> may

> > help or

> > > fund

> > > > this

> > > > > > process for my son?

> > > > > >

> > > > > > Any info whatsoever will help,

> > > > > >

> > > > > >

> > > > >

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