Topic: Getting BC/BS to Consider In-Network Benefits..
RZR
Frequent Contributor (1K+ posts)
Member # 20953
posted
for out-of-network doctor? Is this possible? Would this just cause a red flag?
If BC/BS asks for diagnosis, what do I say?
Anyone have any luck with this? The only reason I am considering is because my in network maximum out-of-pocket is $1500 (almost met) and out-of-network max is $3000.
-------------------- Tick bite May 2009 Diagnosed June 2009 Posts: 2329 | From SouthEast | Registered: Jun 2009
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janice victorov
Frequent Contributor (1K+ posts)
Member # 22937
posted
Jennie, I tried that with BCBS. They will pay 70% percent of an office visit for similiar doctors in that area.
That's 70% of what they think the office visit should be. I saw an llmd out of network for about 6 months. I sent them all my receipts with diagnosis codes. I believe I got something like 469 back out of a 2000g bill overall from the same doctor.
Even though BCBS is one of the beter ones,,,they still reimburse not as much as you pay out of pocket.
-------------------- jkv44 Posts: 1247 | From virginia | Registered: Oct 2009
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blinkie
Frequent Contributor (1K+ posts)
Member # 14470
posted
This was suggested to me but I think the Dr has to go for it. Not sure though.
When I told the rep that suggested it m yDR would never sign up with them, she dropped it.
Posts: 1104 | From N.California | Registered: Jan 2008
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
Most LLMD's do not take insurance, to avoid closer scrutiny about what they are doing.
Mine takes Medicare, for patients who were his patients when they became eligible, and now files my secondary BC/BS.
Since I do not have a positive Lyme test he includes dx codes for things like chronic fatigue, etc., that cover what I am dealing with, without the Lyme jumping out at them.
It has helped immensely. I also have very low deductibles.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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posted
No, the doctor has to be a preferred provider, and very few lyme docs will sign a contract with insurance companies. And the insurance companies don't want them anyway. Several lyme docs had their contracts terminated because it was costing the ins co more than they wanted to pay.
So, consider yourself lucky if your ins co will pay out of network for your doc visits. It will be less, but it will be something.
Posts: 8430 | From Not available | Registered: Oct 2000
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
BCBS has not denied my doctor who is in networks billing and charges using the lyme diagnostic code. No questions asked.
My doctor told me when I asked that it is based on medical necessity and that I should not worry.
And it did work out fine
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- This could vary state to state - or by insurance region. If a state is an "anti-lyme" state, it may be more difficult. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
I recently spoke to a rep at BCBS about my Lyme.
I work for BCBS and received a verbal reprimand for calling out sick. Next is written and then out the door.
I requested the paperwork for FMLA and it was faxed to me.
I took it to my doctor to complete, the reasoning was "serious health condition".
My doctor who is not an LLMD completed the paperwork after telephoning me as to just what I thought that I needed for time off.
I was very pleased to see the paperwork was approved. So I am now covered for the next time that I go down and will not be losing my job.
The woman I spoke with at BCBS was very sympathetic to my situation and even told me that she had received a similar call like mine earlier in the week.
I do not know if the paperwork would have been approved if the condition said Lyme, but because it said serious health condition the request for FMLA was approved.
I hope that I will not have to use it as I have been feeling better.
Nice to know it is there just in case I go down again.
-------------------- cjfrank
IGG Western Blot - negative IGG Bands Detected - p18 IGM Western Blot - positive IGM Bands Detected - p23, p41 Posts: 49 | From Maine | Registered: Jul 2010
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