Hi all! My question: an out-of-network course of care will be affordable to me if all goes well with my health insurance’s out-of-network reimbursement. But I’ve never done this before, and I’m nervous about something going wrong and sustaining financial harm. I’d love insight!!
Are clean claims ever processed in less than 30 days? Any advice on making sure there are no complications?
I will need to file claims for the same provider/treatment once a week for 12 weeks. Should I file a claim the day I get the services rendered each week?
I don’t want to delay care but I don’t want to risk a drawn out reimbursement battle. Is it worth the risk?
Insurance: Anthem BCBS PPO Income: $4200/month after tax and insurance taken out ($1700 fixed costs a month) Zip code: 20008
More details:
I’m looking to start a course of care with a provider that doesn’t take insurance. (Unfortunately this appears to be very common in my city and among providers who specialize in my diagnosis). The treatment plan asks for a weekly session priced at $199 for 3 months, so 12 sessions.
My out-of-network deductible is $800. After that, I get reimbursed 70% of the “in-network cost of care” for the corresponding service.
The good news: I have around $900 in an FSA, so I will be able to use that on the first 4 sessions to hit my deductible without initial out of pocket expenses. Woo!
The issues: once the FSA runs out, I’ll be paying $199 upfront for the remaining 8 sessions and relying on the reimbursement claims to return the remainder.
My financial situation: (22F) no credit, self-sufficient, have a reasonable income, no people to borrow money from. Savings drained from a car repair.
I can definitely afford 70% off of $199– this would net a $60~ payment per week. And I can definitely front the money and live lean for a month or so. But I wouldn’t do this for the full price tag if the reimbursement process wouldn’t work out for some reason.
It’s annoying that they won’t tell me the estimates in network cost of care even with my diagnosis and covered CPT code. What if their estimate is ridiculously low? What recourse would I have?
Is this a basic transaction that I shouldn’t be afraid to do, or do I need to just accept that I need to delay care until I save up for the sticker price.
submitted by /u/puppyddog
[link] [comments]Hi all! My question: an out-of-network course of care will be affordable to me if all goes well with my health insurance’s out-of-network reimbursement. But I’ve never done this before, and I’m nervous about something going wrong and sustaining financial harm. I’d love insight!! Are clean claims ever processed in less than 30 days? Any advice on making sure there are no complications? I will need to file claims for the same provider/treatment once a week for 12 weeks. Should I file a claim the day I get the services rendered each week? I don’t want to delay care but I don’t want to risk a drawn out reimbursement battle. Is it worth the risk? Insurance: Anthem BCBS PPO Income: $4200/month after tax and insurance taken out ($1700 fixed costs a month) Zip code: 20008 More details: I’m looking to start a course of care with a provider that doesn’t take insurance. (Unfortunately this appears to be very common in my city and among providers who specialize in my diagnosis). The treatment plan asks for a weekly session priced at $199 for 3 months, so 12 sessions. My out-of-network deductible is $800. After that, I get reimbursed 70% of the “in-network cost of care” for the corresponding service. The good news: I have around $900 in an FSA, so I will be able to use that on the first 4 sessions to hit my deductible without initial out of pocket expenses. Woo! The issues: once the FSA runs out, I’ll be paying $199 upfront for the remaining 8 sessions and relying on the reimbursement claims to return the remainder. My financial situation: (22F) no credit, self-sufficient, have a reasonable income, no people to borrow money from. Savings drained from a car repair. I can definitely afford 70% off of $199– this would net a $60~ payment per week. And I can definitely front the money and live lean for a month or so. But I wouldn’t do this for the full price tag if the reimbursement process wouldn’t work out for some reason. It’s annoying that they won’t tell me the estimates in network cost of care even with my diagnosis and covered CPT code. What if their estimate is ridiculously low? What recourse would I have? Is this a basic transaction that I shouldn’t be afraid to do, or do I need to just accept that I need to delay care until I save up for the sticker price. submitted by /u/puppyddog [link] [comments]Read Morer/HealthInsurance