CaptBoo wrote:I think the "tipping point" has been reached, at least in my case. BC/BS has just (moments ago) denied pre-approval for my head and neck MRV. They approved my chest MRV.
Ugh. BCBS did mine (ppo though) no problems.
Thing is, it's easy to confuse your insurance company, with your insurance provider
. My insurance provider, i.e. the people who cut the checks the hospital cashes, is IN the BCBS network/umbrella. My provider hasn't changed one tiny dollar in coverage from what they did before, when they were in the other network which you would not recognize, and which it was extremely difficult to find a good doctor. When they changed to BCBS, all the bills and interaction went directly to BCBS, they in turn had charts for what the trust fund covers and doesn't, and paid out accordingly. The actual dollar figure involved (per office visit, how much xrays, all that) hadn't changed, the amount of contractural providers though had exploded, which explains how someone like me in So Cal, working out of a trade union, can go to a hospital 500 miles away and be covered.
However I will say I spent quite a bit of time on the phone with them before ever departing for that expensive adventure. This is so people reaize they may be in the BCBS network, but what your specific insurance company pays or doesn't pay for is specific to that company and needs a lot of investigation beforehand. That's why I think the codes help to at least broach the subject with them first.
I'm assuming you are HMO due to the pre-approval? My codes for the MRI/MRV were 70549 neck+ 70553 brain, radiologist fees. The MRI only says 611 but that may be their internal numbers. Each MRI/MRV (head+neck) was 6207.00 charged, with a benefit amount of 2806.00 each. The rest is contractural writeoffs.
Not sure if that helps, wish everyone could just go in there and get it done without all the headaches.