Additional insurance information

February 29, 2000

Many of us see specialist outside of our normal insurance network. As you

are aware, seeing those doctors outside the preferred network invariably

requires us to " cough-up " (puke is more like it) additional monies for the

privilege. For example, normal coverage may pay 80-90% within the network

while going outside is covered by a lesser amount say 60-70%. My provider

(and they don't advertise this) has what they call a " unique care " form, if

you request it. As the name implies, it says the patients needs are such

that outside specialist treatment is covered as if it is within the

network. It requires the primary care physicians signature to attest.

Therefore, anyone who is interested should inquire. It is my understanding

that the unique care form is a legal requirement on the insurance

companies. Have any of you heard of it? , you may want to add

additional info.

Quentin Seals

Matt's dad ?XLA?

February 29, 2000

Thanks Quentin,

Mine's not issues w/in/out of net work...they just simply didn't want to pay

for things...plus it gets complicated because since we're self employed,

we're not in a big group w/all those gov. standards....But I surely will

keep that in mind ....Thanks for thinking of me!

At 08:08 PM 2/29/00 -0500, you wrote:

>

>Many of us see specialist outside of our normal insurance network. As you

>are aware, seeing those doctors outside the preferred network invariably

>requires us to " cough-up " (puke is more like it) additional monies for the

>privilege. For example, normal coverage may pay 80-90% within the network

>while going outside is covered by a lesser amount say 60-70%. My provider

>(and they don't advertise this) has what they call a " unique care " form, if

>you request it. As the name implies, it says the patients needs are such

>that outside specialist treatment is covered as if it is within the

>network. It requires the primary care physicians signature to attest.

>Therefore, anyone who is interested should inquire. It is my understanding

>that the unique care form is a legal requirement on the insurance

>companies. Have any of you heard of it? , you may want to add

>additional info.

>

>Quentin Seals

>Matt's dad ?XLA?

>

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>This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.

>

February 29, 2000

Quentin, That is why I went to our out of network specialists and ask them

to contract with our HMO so we could still see them. But I know exactly

what your talking about, When we go to NIH the treatment is free but you

have to pay for the travel expense. But I figure the expertise is worth it.

I wish we had a system like Holland or Canada.

take care and hope everyone is well,

annette and alissa

>

>Reply-To: PedPIDonelist

>To: <PedPIDonelist>

>Subject: Additional insurance information

>Date: Tue, 29 Feb 2000 20:08:22 -0500