Insurance out of network question - Empire BCBS

[Guest guest]

We are going through Cranial Technologies for the DOC Band and it's out of

network on our insurance (Empire BCBS). They will only reimburse the

'reasonable and customary amount' which was guessed to be about $700. The DOC

Band is $3800 though! Does anyone know how to get this reasonable and customary

amount to be higher? How does this amount get determined? Any success in a

situation like this?

Thanks!

[Guest guest]

- I recently got Empire BCBS to pay on the full amount instead of the

reasonable and customary amount and process it as in-network instead of

out-of-network, so I'm sure you can too. Where are you located? I'm in

Connecticut, and they told me $700 at first also. I'm going to send you an email

with my correspondence with them, so don't delete it! I found that I got

different answers based on who I spoke to, so keep asking until you get the

answer you want. Also, utilize the online email program through their website so

you get everything in writing from now on. Save the emails into Word and/or

print them out. Going to type that email...

>

> We are going through Cranial Technologies for the DOC Band and it's out of

network on our insurance (Empire BCBS). They will only reimburse the

'reasonable and customary amount' which was guessed to be about $700. The DOC

Band is $3800 though! Does anyone know how to get this reasonable and customary

amount to be higher? How does this amount get determined? Any success in a

situation like this?

>

> Thanks!

>

>