Any way to find out maximum allowable amount? Advice appreciated.

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Hi!

Has anyone had success getting the maximum allowable amount for reimbursement from their insurance provider for a specific billing code / CPT code?

I’m looking to get that from my partner’s insurance and they keep giving me the run around. My partner has chronic pain and has seen countless doctors. Recently referred to an out of network specialist.

Partner has met out of network, out of pocket max for the year, so hoping to be able to get this visit covered, but it’s expensive, and we can’t figure out if insurance will say:

approved! (but we think it should cost $200 not $800 so here’s $200!)

or if they will pay the full amount.

Any advice appreciated – thanks!

Edit – info State: CA Plan: private employer sponsored/funded, administered by Anthem

submitted by /u/leirbagflow
[link] [comments]
Hi! Has anyone had success getting the maximum allowable amount for reimbursement from their insurance provider for a specific billing code / CPT code? I’m looking to get that from my partner’s insurance and they keep giving me the run around. My partner has chronic pain and has seen countless doctors. Recently referred to an out of network specialist. Partner has met out of network, out of pocket max for the year, so hoping to be able to get this visit covered, but it’s expensive, and we can’t figure out if insurance will say: approved! (but we think it should cost $200 not $800 so here’s $200!) or if they will pay the full amount. Any advice appreciated – thanks! Edit – info State: CA Plan: private employer sponsored/funded, administered by Anthem
submitted by /u/leirbagflow [link] [comments]Read Morer/HealthInsurance

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