Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 In a message dated 7/15/00 7:11:27 PM Pacific Daylight Time, sumlinsr@... writes: << , Blue Shield's payment percentage may be significantly reduced. " I looked in my coverage book and it says they only pay 50% for non-participating providers. Today in a post I read that Dr R is a participating provider of bcbs of mn. Why not Ca. >> Go back to them and tell them you want the MGB covered as " in network. " It worked for us! Regards, Debbie in IL Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 Counting on Cigna for Debbie (BMI 40) ins letter sent 7/14 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 Hi Marjory... I am also confused... Do you have a BCBS PPO? Mine is based in Minnesota, but my policy reads that if I ever need to see a doctor out of state, if I see a provider that is in the BCBS PPO network of their state, then it will be paid at full in network rates.. Does that make sense? I sometimes have trouble saying what I'm thinking...lol Maybe not all policies are the same, but Dr. R. IS in the BCBS network in North Carolina, or at least he was when I called my insurance company yesterday. I got approval over the phone on Thursday afternoon, but have not received my letter yet, so I guess I will have to wait and see what it says.. Good luck! Deb in IL P.S. said that even if it is out of network, paying at a lower rate, that your out of pocket limits would still be in effect, so that should help you out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 Marjory, I habe bcbs of AL and they also are counting Dr. R as out of network, they will only pay 70/20 % but as pointed out to me today, find out what their stop loss is. They usually only make the subscriber pay out of pocket up to a certain limit, like $1000 or $1500. I haven't called my ins yet but I plan to on Monday and find out what my stop pay is. My husband says the same thing, but it is just so aggrevating!!! Keep your chin up! Dinah in Ala > I recieved my letter of approval yesterday and was thrilled but as I > read the letter over it makes me a little nervous. The letter is > addressed to Dr R and it is from Blue shield of Ca Select PPO, it > reads in part " Because you are not a Blue Shield participating > provider, the subscribrer is responsible to you for all charges > incurred. Blue Shield issues the explanation of benefits and any > payment directly to the subscriber. Benefits are based on the Blue > Shield allowable amounts, and are payable at the percentage specified > in the member's Evidence of Coverage. When a member recieves service > from a non-participating provider, Blue Shield's payment percentage > may be significantly reduced. " I looked in my coverage book and it > says they only pay 50% for non-participating providers. Today in a > post I read that Dr R is a participating provider of bcbs of mn. Why > not Ca. Do you think they made a mistake? This is sure an emotional > roller coaster ride isn't it. My dear husband assured me that we will > have Dr R do my surgery no matter what, but it bugs me that I am > going to the least expensive Dr in the country for WLS and still they > don't want to pay much. Thanks for listening(reading) to me worry. > Marjory of Ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 DebLaMan@... wrote: > > Go back to them and tell them you want the MGB covered as " in > network. " It > worked for us! > OK, how can you tell them to do this??? Are you sending some big Mafia guys in there, Debbie?? Tricia in IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 The Bardells wrote: > > DebLaMan@... wrote: > > > > > Go back to them and tell them you want the MGB covered as " in > > network. " It > > worked for us! > > > > OK, how can you tell them to do this??? Are you sending some big > Mafia guys in there, Debbie?? > > Tricia in IL I think what she means is that Dr. Rutledge is in the Blue Cross/Blue Shield Network in North Carolina and he should be recognized as " in network " by your Blue Cross/Blue Shield if you push it. Kind regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2000 Report Share Posted July 15, 2000 wrote: > > The Bardells wrote: > > > > DebLaMan@... wrote: > > > > > > > > Go back to them and tell them you want the MGB covered as " in > > > network. " It > > > worked for us! > > > > > > > OK, how can you tell them to do this??? Are you sending some big > > Mafia guys in there, Debbie?? > > > > Tricia in IL > > I think what she means is that Dr. Rutledge is in the Blue Cross/Blue > Shield Network in North Carolina and he should be recognized as " in > network " by your Blue Cross/Blue Shield if you push it. > > Kind regards, > > Gothcha! Tricia = ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 In a message dated 7/15/00 9:30:50 PM Pacific Daylight Time, bardell@... writes: << > > Go back to them and tell them you want the MGB covered as " in > network. " It > worked for us! > OK, how can you tell them to do this??? Are you sending some big Mafia guys in there, Debbie?? Tricia in IL >> LOL Tricia! No, but if they didn't approve I wouldda! Regards, Debbie (Al Capone) in IL Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 Counting on Cigna for Debbie (BMI 40) ins letter sent 7/14 Quote Link to comment Share on other sites More sharing options...
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