Empire BC/BS- Reasonable and Customary

[Guest guest]

Hi,

We recently found out that our insurance provider deemed only $905

as reasonable and customary. We paid the bill upfront to get the 10%

off which is a good thing because we ended up being responsible for

a little over $2600. My husband and I do not know what to do next.

My son is also covered under my insurance BC of CA, but we did not

get a pre-authorization from them. I do not know if I should just

turn in a claim form for my insurance or appeal the amount deemed

reasonable and customary, or do both. Any advice would be

appreciated. Also, I'd like to know what other insurance companies

deem reasonable and customary.

Thanks,

Lee and Nate/CA

DOCbanded since 10/28/03

[Guest guest]

Hi Lee,

My BCBS policy deemed the DOC R & C as $2988 of the $3000. We were

really lucky. I would call your state insurance commissioner's

office and ask their advice to the next step. Keep us posted.

Natasha

> Hi,

>

> We recently found out that our insurance provider deemed only $905

> as reasonable and customary. We paid the bill upfront to get the

10%

> off which is a good thing because we ended up being responsible for

> a little over $2600. My husband and I do not know what to do next.

> My son is also covered under my insurance BC of CA, but we did not

> get a pre-authorization from them. I do not know if I should just

> turn in a claim form for my insurance or appeal the amount deemed

> reasonable and customary, or do both. Any advice would be

> appreciated. Also, I'd like to know what other insurance companies

> deem reasonable and customary.

>

> Thanks,

> Lee and Nate/CA

> DOCbanded since 10/28/03

[Guest guest]

Lee, our insurance carrier paid 100% of the 3k for my daughter's

DOCBand. We were required to get pre-certified (which we did) and

they required a letter of medical necessity (which we sent) and they

had a minimum number for assymetry (which she had). I would agree

with Natasha about calling your State insurance commission to see if

they can help. Trust me, insurance companies pull numbers out of a

hat to deteremine what they will pay. Good luck!

Dustie

> > Hi,

> >

> > We recently found out that our insurance provider deemed only

$905

> > as reasonable and customary. We paid the bill upfront to get the

> 10%

> > off which is a good thing because we ended up being responsible

for

> > a little over $2600. My husband and I do not know what to do

next.

> > My son is also covered under my insurance BC of CA, but we did

not

> > get a pre-authorization from them. I do not know if I should just

> > turn in a claim form for my insurance or appeal the amount deemed

> > reasonable and customary, or do both. Any advice would be

> > appreciated. Also, I'd like to know what other insurance

companies

> > deem reasonable and customary.

> >

> > Thanks,

> > Lee and Nate/CA

> > DOCbanded since 10/28/03