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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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Be sure to check your Insurance documents!
OK, after much deliberating over the cost of overseas and no coverage, I decided to look at my insurance policy with BCBS....this is what i found:
"When you travel outside of the United States, you still have access to your benefit as long as services are provided by a licensed physician or accredited hospital. " It then goes on to describe the BlueCard PPO program and how to find in-network doctors and hospitals. Now, i had called the office before and they told me i have emergency coverage overseas, but no coverage for scheduled operations or things of that nature. So i was bummed about that. But, she wasn't completely sure. Now that i have it in WRITING on my plan....should i just do it, and forego a pre-authorization ?? Has anyone else had this on their BCBS plan and still did not get covered?? I understand there is still the matter of "experimental." Does "experimental" get thrown out the window in an environment not bound by the FDA, so long as it is medically necessary?? Anyway, this is a big step in the right direction towards coverage. All i would have to do is prove that in Europe, it is not experimental(in case i do have to fight), which shouldn't be too difficult considering they've been doing it for 20+ years. Anyone here have overseas coverage with Blue Cross Blue Shield and still didn't get covered?
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2013 - MRI and CT scan....DDD L4-S1 left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine. |
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Confused....if they are in-network with BCBS and they recognize it as the standard back surgery outside the U.S, then why would pre-authorization kill the chance for reimbursement?
Anyways, my policy states... "Most hospitals and doctors in foreign countries will ask you to pay the bill up front. Try to get itemized receipts, preferably written in English." Most likely i will have to pay the "upfront" bill. So i guess pre-authorization wouldn't really be necessary? If Clavel's office is in-network, why wouldn't they just submit the billing themselves? I don't know, got questions i need answered.
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2013 - MRI and CT scan....DDD L4-S1 left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine. |
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