Guest guest Posted February 12, 2004 Report Share Posted February 12, 2004 I was out on the Totallyhip list last night and see that you guys can have just about as much trouble trying to get an insurance coy to cover a THR inUS as a Resurface Edith, The people having the most trouble are probably those with HMO (Health Maintenance Organization) or PPO (Preferred Provider Option). If a particular doc or hospital is not on your companies list, I guess it can be fits to get things approved. I was fortunate in that my OS is on my list. When I had to switch primary care docs (as my other was no longer on the list), I just told him who my OS was, and that I needed his referral. I never mentioned resurfacing, he didn't seem to care, and I got my referral. Now my former primary care doc is back on the list, so I get to see her again. I think every country has their headaches to deal with... Cindy C+ 5/25/01 and 6/28/01 _______________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2004 Report Share Posted February 13, 2004 > > I was out on the Totallyhip list last night and see that you guys can have just about as much trouble trying to get an insurance coy to cover a THR inUS as a Resurface > Edith, > The people having the most trouble are probably those with HMO (Health Maintenance Organization) or PPO (Preferred Provider Option). I think you may be confusing PPOs and EPOs (Exclusive Provider). Most PPOs will still cover procedures by providers outside the " network " , although at a reduced reimbursement. For example, my PPO covers most " in-network " services at 90% and " out-of-network " providers at 80%. The EPO option offered by my employer provides essentially no coverage for services furnished by " out of network " providers. I believe there's an exception for medical emergencies when travelling out of the area, but I wouldn't swear to it. People with PPOs have nowhere near as much trouble as those with EPOs or HMOs, but they're about the best one can get these days. My previous employer didn't even offer a PPO, just a " choice " of two different HMOs. I can only imagine how bewildering the Brits, Canadians, Aussies, French, etc. must find this mishmash of abbreviations. Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 I think you may be confusing PPOs and EPOs (Exclusive Provider). Most PPOs will still cover procedures by providers outside the " network " ,although at a reduced reimbursement. Yes, but 20% of $25,000 is still a large chunk of change. I would not have been able to afford it if I'd had to pay more than I did. I may have mixed up my letters--my license is in property and casualty insurance, not life and health. I don't do any better at the health insurance stuff than anyone else. I can only imagine how bewildering the Brits, Canadians, Aussies,French, etc. must find this mishmash of abbreviations. LOL-they have their own abbreviations and expressions that sometimes make it difficult to believe that we are all speaking the same language. I've had to ask for translations more than once! Cindy C+ 5/25/01 and 6/28/01 _______________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 1, 2012 Report Share Posted June 1, 2012 Hi, I am currently up for renewal through Florida KidCare. I did not get approved for CMS. Does anyone know if any of the managed care plans in broward cover ABA services? Thanks so much for any response. Margaret Quote Link to comment Share on other sites More sharing options...
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