BCBS PPO - FEP

[Guest guest]

I just got a letter from BCBS. They sent me a check for $1200. They say that

the " plan allowance " is $1710 and they will pay 70% of that, which comes out to

$1200. I paid $2650 for the band....so they're really only paying about 45%.

Anyone else deal with a low " plan allowance " ? They write that " there are no

additional benefits available for the portion of the charge that exceeds the

plan allowance " . I've been fighting with them since May and finally got a check

for a portion...should I just be happy with what I got and not continue to fight

(b/c I won't get any more money) or should I try to get the additional 55%?

[Guest guest]

sorry but this sounds normal, thats why most specialists dont contract with insurance b/c if they do you cant be held responsible for the remainder, they have to eat it.  insurance has an allowance for everything, they you have to meet your deductible and then they only pay their portion.  i do not know what our allowance was but i know that had me gone through bcbs (our ins) we were told there was probably a 1% chance they would pay anything, even after losing the lawsuit here in sc.  but if they did, we paud $2700 for the band.  we would have had to meet out $750 deductible b/c it was out of network) then they would have paid only 60% of the remainder of the allowance so they would have paid, at most $1170.  luckily dh work is self insured so we were able to bypass bcbs (just the filing agent) and get a caseworker who got it preapproved, covered at cost and in network (so after $250 deductible they paid 80% of it)

On Wed, Sep 16, 2009 at 1:32 PM, jenluck123 <jenluck123@...> wrote:

 

I just got a letter from BCBS. They sent me a check for $1200. They say that the " plan allowance " is $1710 and they will pay 70% of that, which comes out to $1200. I paid $2650 for the band....so they're really only paying about 45%. Anyone else deal with a low " plan allowance " ? They write that " there are no additional benefits available for the portion of the charge that exceeds the plan allowance " . I've been fighting with them since May and finally got a check for a portion...should I just be happy with what I got and not continue to fight (b/c I won't get any more money) or should I try to get the additional 55%?

-- -mommy to Emma, Becca, , and A truly rich man is one whose children run into his arms when his hands are empty.  ~Author Unknown