Re: UCR for band??? Insurance question

July 30, 2008

We got the star band and paid $2,650. (Cranial Kids in Hollywood,Fl) Our insurance approved it as out-of-network. We paid a deductible of $200, then they reimbursed us 80% of the leftover costs. We paid up front. So in the end the insurance paid $1,950 towards the band.

From: missmailelynn <mailelynn@...>Subject: UCR for band??? Insurance questionPlagiocephaly Date: Wednesday, July 30, 2008, 4:40 PM

Wow - I haven't even had a chance to introduce myself and I already have a question.My Son has been referred by his Pedi for an evaluation for a band, and I have two options, Cranial Tech and Star Cranial Center. I would prefer to take him to Cranial Tech, however they are out of network with my insurance company (Star is in network).My question is this: For those of you who had a claim paid by your insurance companies and if the service was out of network, what was the allowed amount for the service. For example, Cranial Tech advised that their band/treatment is $3600, what was the allowed amount that your insurance company used to calculate your benefits. We would have to pay a percentage of that amount, plus whatever the difference is between the insurance allowed amount and the $3600.We have an appointment set with Cranial Tech on Friday, but I need to know what the allowed will

be in order to decide which one is the better choice financially.Thanks in Advance - Maile Mom to Kaden, 6 months

July 30, 2008

Maile,We have Destiny Health in IL. Our allowable in network expense for an orthotic device is $2,000. They pay 70% of that amount (about $14,00) on our band. It was our experience that when CT called the insurance company, they would not tell CT what the allowable amounts were. I have no idea why, unless they thought CT might try to categorize it as something different.All of that said, for some reason our insurance actually ended up paying the full$2,000. I don't know if it was a mistake or what so I'm just keeping my fingers crossed!Good luck! As if it's not trouble enough to go through this with your child, you then have to spend countless hours

figuring out insurance companies! aaarrrggghhhh.Sandymom to Lyla - 8 months (8 weeks in a Doc Band)and Owen 4 UCR for band??? Insurance question

Wow - I haven't even had a chance to introduce myself and I already

have a question.

My Son has been referred by his Pedi for an evaluation for a band,

and I have two options, Cranial Tech and Star Cranial Center. I

would prefer to take him to Cranial Tech, however they are out of

network with my insurance company (Star is in network).

My question is this: For those of you who had a claim paid by your

insurance companies and if the service was out of network, what was

the allowed amount for the service. For example, Cranial Tech

advised that their band/treatment is $3600, what was the allowed

amount that your insurance company used to calculate your benefits.

We would have to pay a percentage of that amount, plus whatever the

difference is between the insurance allowed amount and the $3600.

We have an appointment set with Cranial Tech on Friday, but I need to

know what the allowed will be in order to decide which one is the

better choice financially.

Thanks in Advance -

Maile

Mom to Kaden, 6 months

July 30, 2008

Sorry, I forgot to say that CT was out of network for our insurance, so that's why they only covered 70% of the allowable amount. UCR for band??? Insurance question