Guest guest Posted October 13, 2005 Report Share Posted October 13, 2005 My son has been undergoing treatment with Dr. Goldberg for 5 years now and we are very happy with his progress. It has been very slow but steady. He is now 15 years old and with the exception of his echolalia, everything else seems very normal. He attends regular private school. Recently, our company sent out our medical enrollment packet for 2006 and is switching to Cigna PPO. I am concerned that Dr. Goldberg does not accept Cigna Insurance and I don't know how this will work out. does anyone have Cigna PPO ? What is your experience regarding their coverage with doctors outside their network ? How about medications ? Any information will be highly appreciated. By the way, we live here in Southern California, Torrance area. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 If Dr. Goldberg is not in the ppo system for your insurance, then you can still go to him. But the reimbursement will be less. You will have to pay more out of pocket for the doctor visits. You will have to pay Dr. G up front and then send the bills to your insurance for reimbursement. We have done this for 3 years now, and it has worked out. Barb --- kzhmr1 <kzhmr1@...> wrote: > My son has been undergoing treatment with Dr. > Goldberg for 5 years now > and we are very happy with his progress. It has > been very slow but > steady. He is now 15 years old and with the > exception of his > echolalia, everything else seems very normal. He > attends regular > private school. > > Recently, our company sent out our medical > enrollment packet for 2006 > and is switching to Cigna PPO. I am concerned that > Dr. Goldberg does > not accept Cigna Insurance and I don't know how this > will work out. > does anyone have Cigna PPO ? What is your experience > regarding their > coverage with doctors outside their network ? How > about medications ? > Any information will be highly appreciated. By the > way, we live here in > Southern California, Torrance area. > > > > > > Barb Katsaros barbkatsaros@... __________________________________ Music Unlimited Access over 1 million songs. Try it free. http://music./unlimited/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Thanks Barb for your response, how about the lab work. Do you go to a lab within the network ? If so, is the labwork covered as in network or still out of network ? How about medication ? Is it in network if you go to a pharmacy within their network or are all medications considered out of network since it is prescribed by Dr. G. Also, does Dr. G give you a better rate since he is paid upfront ? Any information is highly appreciated. Thanks and I am very glad I sign up with this group. Barb Katsaros <barbkatsaros@...> wrote: If Dr. Goldberg is not in the ppo system for your insurance, then you can still go to him. But the reimbursement will be less. You will have to pay more out of pocket for the doctor visits. You will have to pay Dr. G up front and then send the bills to your insurance for reimbursement. We have done this for 3 years now, and it has worked out. Barb --- kzhmr1 <kzhmr1@...> wrote: > My son has been undergoing treatment with Dr. > Goldberg for 5 years now > and we are very happy with his progress. It has > been very slow but > steady. He is now 15 years old and with the > exception of his > echolalia, everything else seems very normal. He > attends regular > private school. > > Recently, our company sent out our medical > enrollment packet for 2006 > and is switching to Cigna PPO. I am concerned that > Dr. Goldberg does > not accept Cigna Insurance and I don't know how this > will work out. > does anyone have Cigna PPO ? What is your experience > regarding their > coverage with doctors outside their network ? How > about medications ? > Any information will be highly appreciated. By the > way, we live here in > Southern California, Torrance area. > > > > > > Barb Katsaros barbkatsaros@... __________________________________ Music Unlimited Access over 1 million songs. Try it free. http://music./unlimited/ Responsibility for the content of this message lies strictly with the original author(s), and is not necessarily endorsed by or the opinion of the Research Institute and/or the Parent Coalition. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2005 Report Share Posted October 15, 2005 I try to use within the network as much as possible as it is cheaper. If I go to certain pharmacies, I get a lower rate. If I use a certain lab, I get a lower rate. Quest is one of the labs we can use, and that is one that Dr. G likes. No, Dr. G does not give a different rate if you pay up front. But if he is in a certain network, as he used to be for Blue Cross/BS, his office will bill your insurance. I do not know if this is less than what he charges up front. Actually, our insurance paid every bit of Dr. G's appts, so he must be reasonable for the California area, because our insurance does U and C big time. We don't have your insurance, so I can't give you specifics, but I would work with your ins. and get as much help from them as you can to get the lowest amts. on txs. If you have a ppo which doesn't include Dr. G, you might have to pay a certain percentage that they charge for outside of ppo. We do not have to use the ppo, but we are subject to the U and C. This ins. stuff can get very complicated. Good luck! --- Barrera <kzhmr1@...> wrote: > Thanks Barb for your response, how about the lab > work. Do you go to a lab within the network ? If > so, is the labwork covered as in network or still > out of network ? How about medication ? Is it in > network if you go to a pharmacy within their network > or are all medications considered out of network > since it is prescribed by Dr. G. > > Also, does Dr. G give you a better rate since he is > paid upfront ? > > Any information is highly appreciated. Thanks and I > am very glad I sign up with this group. > > Barb Katsaros <barbkatsaros@...> wrote: > If Dr. Goldberg is not in the ppo system for your > insurance, then you can still go to him. But the > reimbursement will be less. You will have to pay > more > out of pocket for the doctor visits. You will have > to > pay Dr. G up front and then send the bills to your > insurance for reimbursement. We have done this for > 3 > years now, and it has worked out. Barb > > --- kzhmr1 <kzhmr1@...> wrote: > > > My son has been undergoing treatment with Dr. > > Goldberg for 5 years now > > and we are very happy with his progress. It has > > been very slow but > > steady. He is now 15 years old and with the > > exception of his > > echolalia, everything else seems very normal. He > > attends regular > > private school. > > > > Recently, our company sent out our medical > > enrollment packet for 2006 > > and is switching to Cigna PPO. I am concerned that > > Dr. Goldberg does > > not accept Cigna Insurance and I don't know how > this > > will work out. > > does anyone have Cigna PPO ? What is your > experience > > regarding their > > coverage with doctors outside their network ? How > > about medications ? > > Any information will be highly appreciated. By the > > way, we live here in > > Southern California, Torrance area. > > > > > > > > > > > > > > > Barb Katsaros > barbkatsaros@... > > > > __________________________________ > Music Unlimited > Access over 1 million songs. Try it free. > http://music./unlimited/ > > > Responsibility for the content of this message lies > strictly with > the original author(s), and is not necessarily > endorsed by or the > opinion of the Research Institute and/or the > Parent Coalition. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Barb is right, as long as your PPO DOES provide out of network benefits as well. They usually do, but I have seen some that did not cover anyone out of network (those are usually HMOs but you'll find a couple out there who are PPOs). Most likely your policy book will show a breakdown of how they cover in-network vs out-of-network, or you can call the benefits line at your insurance and confirm. One other thing to ask when trying to calculate potential expenses is: Do they pay, for example, 60% of the out of netwk physician's FEE, or only the their " allowed " fee? (their fee schedule, or what they may call " usual and customary - a real joke). You also want to ask what the difference between in-netwk deductible and out of net deductible. And finally, just confirm that labs ordered by an out-of-net doctor will still be paid in-network benefits as long as it is an in-network lab. HTH- --- Barb Katsaros <barbkatsaros@...> wrote: > If Dr. Goldberg is not in the ppo system for your > insurance, then you can still go to him. But the > reimbursement will be less. You will have to pay > more > out of pocket for the doctor visits. You will have > to > pay Dr. G up front and then send the bills to your > insurance for reimbursement. We have done this for > 3 > years now, and it has worked out. Barb > __________________________________ Music Unlimited Access over 1 million songs. Try it free. http://music./unlimited/ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.