Re: Anyone have BCBS PPO of Michigan? To cover s?

[Guest guest]

Reid--

We have BCBS PPO of Mass... it all depends on the policy. Have you called them

and asked

whether or not they cover the billed codes? Many policies do cover DME or

prosthetics,

you just have to call and find out, and they usually don't cover a big dollar

amount per

year. Our annual max is only $1500 per member per year! Call and ask if they

cover CPT

codes L1907 (afo/shoes) and L3150 (bar) and see what they say. Also ask (if

they do

cover) what the allowed amount is, because you'll be responsible for your copay

plus the

difference between what the insurance allows and how much is billed. In our

case,

s cost $382 minus shipping and the impression kit ($32) so the total ins

will

consider is $350 initially. They allow the entire amount for the shoes and

allow

considerably less than the total billed for the bar, so we're responsible for

our percentage

of the shoes, the % plus difference in cost on the bar, plus s/h and impression

kit. For

each additional pair of shoes we're responsible for a percentage of the $264

fee. We also

have a deductible, so that's something else to consider with your policy. We'll

be paying

almost the entire billed amount for the inital setup of bar and shoes, but

afterward will

only be paying a percentage of the shoe cost. We're willing to pay the

additional because

of what we've read from parents on this board about the 's superiority

(in many

cases, anyway)... Next year we may not be able to afford doing so, so we'll do

what we can

while we can, if that makes sense. Most ins companies also have a member

out-of-pocket

max per year, so ask about that, too. It gets crazy, but the kids are well

worth the trouble

with the ins companies!! Oh, and don't use the word " SHOES " because they'll

pounce and

tell you they don't cover those... Make sure you use the terms brace and

replacement

brace!! Let me know if I can help you... If you can, take a look at your

subscriber

certificate... Email me privately if you want me to try helping further!

Hope this helps a little,

Stacee

s.schwander@...

-- In nosurgery4clubfoot , " jones_reid " <jones_reid@y...> wrote:

>

> Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> the 's shoes but cost is pretty enormous. Anyone can help, I

> would appreciate it. Thanks

>

> Reid

>

> Austin 8/1/05

>

[Guest guest]

Have you submitted all documentation, prescriptions, etc. We have Federal BCBS

which is pretty much the same. If I had to come to Michigan for treatment our

claims would be paid from there not here in Arkansas so I would think the rules

would be the same. Do you know if you have coverage for durable medical

eqiupment?

Mommy to

jones_reid wrote:

Just wondering if anyone has BCBS PPO of Michigan? Would like to get

the 's shoes but cost is pretty enormous. Anyone can help, I

would appreciate it. Thanks

Reid

Austin 8/1/05

[Guest guest]

We have BCBS PPO of MI and have had everything covered. We have really felt so

lucky at the amount of coverage we have. When we decided to go to Iowa for

treatment we called BCBS and they said that they would cover anything in Iowa as

they would cover it in Michigan as long as the Doctor/ provider participated

with BCBS PPO of Iowa. Hanger Orthotics as offices in MI so it hasn't been a

problem. We got our first pair of shoes through the clinic in Iowa but for our

second pair we just went to the closest Hanger office for the molds to be taken.

They had few questions as far as how to bill and where they were getting the

shoes from (they had never seen shoes like these!), but really the whole thing

was rather easy and completely covered by insurance.

M wrote: Have you submitted all documentation,

prescriptions, etc. We have Federal BCBS which is pretty much the same. If I

had to come to Michigan for treatment our claims would be paid from there not

here in Arkansas so I would think the rules would be the same. Do you know if

you have coverage for durable medical eqiupment?

Mommy to

jones_reid wrote:

Just wondering if anyone has BCBS PPO of Michigan? Would like to get

the 's shoes but cost is pretty enormous. Anyone can help, I

would appreciate it. Thanks

Reid

Austin 8/1/05

[Guest guest]

Would you mind divulging how much Hanger is charging for the shoes? I remember

Joyce

telling me that if we went through insurance and had Hanger bill for us, the

charge would

be around $1400 for each set of shoes vs $350 ordering via mail and impression

kit,

paying up front, and getting reimbursed by BCBS.

Thanks!

Stacee

> Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> the 's shoes but cost is pretty enormous. Anyone can help, I

> would appreciate it. Thanks

>

> Reid

>

> Austin 8/1/05

>

>

>

>

>

>

[Guest guest]

Now, that is some sort of rip off!!!!!

littleman1013 wrote: Would you mind divulging how much

Hanger is charging for the shoes? I remember Joyce

telling me that if we went through insurance and had Hanger bill for us, the

charge would

be around $1400 for each set of shoes vs $350 ordering via mail and impression

kit,

paying up front, and getting reimbursed by BCBS.

Thanks!

Stacee

> Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> the 's shoes but cost is pretty enormous. Anyone can help, I

> would appreciate it. Thanks

>

> Reid

>

> Austin 8/1/05

>

>

>

>

>

>

[Guest guest]

Agreed!!

I just got off the phone with the two local Hanger Orthotics offices, neither of

which has

ever heard of the shoe/brace! It's simply amazing to me that it's so

difficult to

find this stuff in a very large metropolitan area such as Chicago!!! I guess

I'm completely

confused, now... If Hanger is the only place to get the s from, why

don't they know

anything about them? I've never heard of going to an orthotics place to get

something

that another company(or man, in this case) makes. However, I'm upset now,

too... if the

cost is the same, which it should be, then we'll end up paying much more than we

should

out of pocket going directly through .

I would love to hear everything about your experience, !!

Stacee

> > Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> > the 's shoes but cost is pretty enormous. Anyone can help, I

> > would appreciate it. Thanks

> >

> > Reid

> >

> > Austin 8/1/05

> >

> >

> >

> >

> >

> >

[Guest guest]

I think... that can bill your insurance for you. Don't know

for sure, but he does have the correct codes for insurance

billing. Ask Jeanne.

The price some orthotists are charging for these is

outrageous. They're $382 with the bar. $1400 is something like 300%

markup... ridiculous.

Kori

At 11:32 AM 1/6/2006, you wrote:

>Agreed!!

>

>I just got off the phone with the two local Hanger Orthotics

>offices, neither of which has

>ever heard of the shoe/brace! It's simply amazing to me

>that it's so difficult to

>find this stuff in a very large metropolitan area such as

>Chicago!!! I guess I'm completely

>confused, now... If Hanger is the only place to get the s

>from, why don't they know

>anything about them? I've never heard of going to an orthotics

>place to get something

>that another company(or man, in this case) makes. However, I'm

>upset now, too... if the

>cost is the same, which it should be, then we'll end up paying much

>more than we should

>out of pocket going directly through .

>

>I would love to hear everything about your experience, !!

>

>Stacee

>

>

>

> > > Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> > > the 's shoes but cost is pretty enormous. Anyone can help, I

> > > would appreciate it. Thanks

> > >

> > > Reid

> > >

> > > Austin 8/1/05

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

The actual billing of the insurance is painfully simple... Reimbursing may be a

totally

different story, though! I did get the codes from Jeanne, so we're good to go

there.

To make things worse, the $382 includes shipping and impression kit!!! That's

another

$32 that orthotists shouldn't be charging for!!!

Irritating. Makes you wonder if a socialist healthcare system is so bad, after

all!! :-)

Stacee

> > > > Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> > > > the 's shoes but cost is pretty enormous. Anyone can help, I

> > > > would appreciate it. Thanks

> > > >

> > > > Reid

> > > >

> > > > Austin 8/1/05

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

anyone have a link to the website or his email address? Thanks

reid

littleman1013 wrote:

The actual billing of the insurance is painfully simple... Reimbursing may be

a totally

different story, though! I did get the codes from Jeanne, so we're good to go

there.

To make things worse, the $382 includes shipping and impression kit!!! That's

another

$32 that orthotists shouldn't be charging for!!!

Irritating. Makes you wonder if a socialist healthcare system is so bad, after

all!! :-)

Stacee

> > > > Just wondering if anyone has BCBS PPO of Michigan? Would like to get

> > > > the 's shoes but cost is pretty enormous. Anyone can help, I

> > > > would appreciate it. Thanks

> > > >

> > > > Reid

> > > >

> > > > Austin 8/1/05

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

It's www.mdorthopaedics.com

> > > > > Just wondering if anyone has BCBS PPO of Michigan? Would

like to get

> > > > > the 's shoes but cost is pretty enormous. Anyone

can help, I

> > > > > would appreciate it. Thanks

> > > > >

> > > > > Reid

> > > > >

> > > > > Austin 8/1/05

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >