I have been going back and forth with the insurance company about gcs trans surgery coverage, but everyone is out of network. For out of network they cover 50 percent, for in network it’s more than that. I asked them about out of network exceptions, and this is their reply: “for your plan the discount is only available for medical emergencies which this would not qualify as. If a reduced billed amount is agreed upon, the claim would still process as out of network. The only difference is that the claims would process as agreed amount and not based on reasonable and customary. Those are only done after the claim is recieved though and not done prior to surgery.” I’m trying so hard to underatand the meaning but I can’t understand and it’s making me crazy. Are they saying, yes we’ll pay for it but after? I’m so confused. I don’t know if I can afford 50 percent. I am in north Carolina, the surgeon I am trying to see is in NY
submitted by /u/arthursbeardbone
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I have been going back and forth with the insurance company about gcs trans surgery coverage, but everyone is out of network. For out of network they cover 50 percent, for in network it’s more than that. I asked them about out of network exceptions, and this is their reply: “for your plan the discount is only available for medical emergencies which this would not qualify as. If a reduced billed amount is agreed upon, the claim would still process as out of network. The only difference is that the claims would process as agreed amount and not based on reasonable and customary. Those are only done after the claim is recieved though and not done prior to surgery.” I’m trying so hard to underatand the meaning but I can’t understand and it’s making me crazy. Are they saying, yes we’ll pay for it but after? I’m so confused. I don’t know if I can afford 50 percent. I am in north Carolina, the surgeon I am trying to see is in NY
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