Re: CAM -Boachie/insurance

[Guest guest]

Hi there - I'll expand on this one-

For the consultation, you will have to pay $450 up front and then submit it

to your insurance carrier. If you do choose surgery, Boachie's office

submits the bills to your insurance carrier and they will determine payment

back to you since he is out of network. I received a couple of checks from

my insurance company and passed them on to Boachie's office. I'm in the

process of appealing for more money for the surgery I had. Anthem Blue

Cross/Blue Shield of Virginia (my coverage) didn't reimbursement very well.

In fact, I just appealed to the Virginia Insurance Commissioner and he

questioned Anthem's payment to me.

I received a call from Anthem and they did evaluate my surgery incorrectly,

so my claim is being re-examined. I keep Theresa at Dr. Boachie's office in

the loop with my letters and exactly what Anthem is and is not reimbursing

me. I haven't paid anything to Dr. B out of my pocket yet until Anthem's

answers are final. As long as I keep Theresa informed she has agreed to

wait on my balance. I think they have been so nice - since my surgery was

November 8th, 2005.

Lorrie Snyder

[ ] CAM -Boachie/insurance

Mornin' Cam. Just wondering; if Boachie does not " accept " insurance,

does that mean patients pay up front (full cost, whatever that

is?), " finance " thru his office, or make payments while THEY go thru

the process of submitting everything to insurances to then pay him

balance? ...if you know. Smiles. I could see why that would be

something that any of us would prefer to avoid... unless one really

felt that Boachie was the only doc to do the job. ...which I know he

is a superior choice for revision. Thanks, Marty

scoliosis veterans * flatback sufferers * revision candidates

[Guest guest]

Having just been through all this insurance stuff, I am putting my 2 cents in: be very careful when dealing with these insurance people. Call and then call again (and get someone else on the line). Often times the people themselves who are taking your calls don't really know how it works when they get an inquiry that's a little out of the ordinary,

My primary insurer is Medicare, and I knew when I made my first appt. with my surgeon that he had "opted out" of Medicare years ago, however was told by TWO Medicare clerks or whatever they are that we could pay up front our-selves and then put in a claim ourselves to be reimbursed.

NOT SO!!

THEN I was told by three different clerks at our secondary insurerer (Tricare for Life) that when Medicare is out of the picture Tricare for Life steps into first position and will reimburse the patient. TRUE, but only for the amount that they would have paid in the first place, so we will get about 25% back.

A big sacrifice for us, but I am not about to change surgeons at this late date.

So y'all, check carefully......

>> Hi there - I'll expand on this one-> > For the consultation, you will have to pay $450 up front and then submit it> to your insurance carrier. If you do choose surgery, Boachie's office> submits the bills to your insurance carrier and they will determine payment> back to you since he is out of network. I received a couple of checks from> my insurance company and passed them on to Boachie's office. I'm in the> process of appealing for more money for the surgery I had. Anthem Blue> Cross/Blue Shield of Virginia (my coverage) didn't reimbursement very well.> In fact, I just appealed to the Virginia Insurance Commissioner and he> questioned Anthem's payment to me. > > I received a call from Anthem and they did evaluate my surgery incorrectly,> so my claim is being re-examined. I keep Theresa at Dr. Boachie's office in> the loop with my letters and exactly what Anthem is and is not reimbursing> me. I haven't paid anything to Dr. B out of my pocket yet until Anthem's> answers are final. As long as I keep Theresa informed she has agreed to> wait on my balance. I think they have been so nice - since my surgery was> November 8th, 2005.> > Lorrie Snyder> > [ ] CAM -Boachie/insurance> > Mornin' Cam. Just wondering; if Boachie does not "accept" insurance, > does that mean patients pay up front (full cost, whatever that > is?), "finance" thru his office, or make payments while THEY go thru > the process of submitting everything to insurances to then pay him > balance? ...if you know. Smiles. I could see why that would be > something that any of us would prefer to avoid... unless one really > felt that Boachie was the only doc to do the job. ...which I know he > is a superior choice for revision. Thanks, Marty> > > > > > > scoliosis veterans * flatback sufferers * revision candidates >

[Guest guest]

Marty (and Jolynn), we haven't heard from Andy Stanton in a while, but she

had her revision with Dr. Boachie. Perhaps anyone interested could contact

her and ask how she handled it.

Sharon

[ ] CAM -Boachie/insurance

> Mornin' Cam. Just wondering; if Boachie does not " accept " insurance,

> does that mean patients pay up front (full cost, whatever that

> is?), " finance " thru his office, or make payments while THEY go thru

> the process of submitting everything to insurances to then pay him

> balance? ...if you know. Smiles. I could see why that would be

> something that any of us would prefer to avoid... unless one really

> felt that Boachie was the only doc to do the job. ...which I know he

> is a superior choice for revision. Thanks, Marty

>

>

>

>

>

>

> scoliosis veterans * flatback sufferers * revision candidates

>

[Guest guest]

Oh, that's right, Lorrie, you had Dr. Boachie as surgeon also. That's good

to know, that his staff is being reasonable about reimbursement.

Sharon

[ ] CAM -Boachie/insurance

Mornin' Cam. Just wondering; if Boachie does not " accept " insurance,

does that mean patients pay up front (full cost, whatever that

is?), " finance " thru his office, or make payments while THEY go thru

the process of submitting everything to insurances to then pay him

balance? ...if you know. Smiles. I could see why that would be

something that any of us would prefer to avoid... unless one really

felt that Boachie was the only doc to do the job. ...which I know he

is a superior choice for revision. Thanks, Marty

scoliosis veterans * flatback sufferers * revision candidates

[Guest guest]

Have you ever used Tricare as a secondary payer with standard

medical insurance? Not Medicare? We will qualify for Tricare this

fall, but still have insurance with my husband's work. My family doc

has said we should just dump our " regular " insurance once we qualify

for Tricare but I don't know about that!

Kathy

> >

> > Hi there - I'll expand on this one-

> >

> > For the consultation, you will have to pay $450 up front and then

> submit it

> > to your insurance carrier. If you do choose surgery, Boachie's

office

> > submits the bills to your insurance carrier and they will

determine

> payment

> > back to you since he is out of network. I received a couple of

checks

> from

> > my insurance company and passed them on to Boachie's office. I'm

in

> the

> > process of appealing for more money for the surgery I had.

Anthem Blue

> > Cross/Blue Shield of Virginia (my coverage) didn't reimbursement

very

> well.

> > In fact, I just appealed to the Virginia Insurance Commissioner

and he

> > questioned Anthem's payment to me.

> >

> > I received a call from Anthem and they did evaluate my surgery

> incorrectly,

> > so my claim is being re-examined. I keep Theresa at Dr. Boachie's

> office in

> > the loop with my letters and exactly what Anthem is and is not

> reimbursing

> > me. I haven't paid anything to Dr. B out of my pocket yet until

> Anthem's

> > answers are final. As long as I keep Theresa informed she has

agreed

> to

> > wait on my balance. I think they have been so nice - since my

surgery

> was

> > November 8th, 2005.

> >

> > Lorrie Snyder

> >

> > [ ] CAM -Boachie/insurance

> >

> > Mornin' Cam. Just wondering; if Boachie does not " accept "

insurance,

> > does that mean patients pay up front (full cost, whatever that

> > is?), " finance " thru his office, or make payments while THEY go

thru

> > the process of submitting everything to insurances to then pay

him

> > balance? ...if you know. Smiles. I could see why that would be

> > something that any of us would prefer to avoid... unless one

really

> > felt that Boachie was the only doc to do the job. ...which I

know he

> > is a superior choice for revision. Thanks, Marty

> >

> >

> >

> >

> >

> >

> > scoliosis veterans * flatback sufferers * revision candidates

> >

[Guest guest]

Marty,

Sorry, I wasn't ignoring you, I was away for the weekend! Yes to your

question...and I think Lorrie has already answered it. When I got a

2nd opinion for DrBoachie, I paid his bill in full, submitted the

itemized bill to BC/BS and was reimbursed at a lower rate because he

was " out of network " .

As Lorrie said, the Boachie office staff was very helpful. They went

so far as to seeing if I was going to be able to get a pre-

determination of benefits from BC/BS where they would say how much

they would pay for the revision based of the procedure outlined in

writing, but they would not. So, even though I had complete confidence

that in the long run it would work out okay, I just couldn't see why I

would stress myself over the billing piece when I really liked the

approach Rand was proposing and NEBH was a good deal easier from the

travel perspective....and he was in network. In retrospect, I am very

happy that I made the decision that I did.

I would still gladly pay whatever it took " out of pocket " to get an

opinion from any of the top doctors....you just have to be prepared to

await reimbursement and know that it will be a slightly lower amount.

Figuring out the $$/insurance details is a challenge. Sometimes I

think they just hope we throw our hands up in digust and pay the bills

withour scrutiny.

Take Care, Cam

[Guest guest]

Cam, Thanks, I appreciate any and all input. Marty