Re: UCR for band??? Insurance question

[Guest guest]

Welcome-

I think you would have to ask that specific question to your

insurance company. Who do you have? I have BCBS of NC Federal

Employee Program and were in a similar situation. CT was out of

network and the STARBand provider was in network. I had coverage of

75% for out of network. I submitted my claim for $3000 (CT was

charging $3300 at the time and I got 300 off for paying in full) and

BSBS FEP allowed for the full amount. So I was reimbursed over $2100

after our deductible. I just posted about this the other day, I was

worried that they weren't going to allow for that amount. I was led

to believe (by someone at CT) that they would probably only allow

for $600 before the deductible. But I called my insurance company

directly and asked. They couldn't give me a dollar amount but they

said they would allow for whatever the claim stated. So luckily it

worked out.

Maybe if you post your insurance company and state, we can better

answer your question. I would also still call and ask directly

though, and document the phone call (date/time/representative) in

case you would need it for appeal or dispute purposes.

Good luck!

Jake-22m (tort resolved/rt plagio/DOCBand)

Jordan-4

>

> 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

>

[Guest guest]

I am specifically looking for BCBS in Texas. Our plan is through

BCBS of Alabama, but the claims are processed in Texas.

Thanks for pointing out that I forgot to include that in my original

post !

> >

> > 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

> >

>

[Guest guest]

UCR is based on the location of the provider and what other providers in the area charge.

After working many years in the HR field I can tell you that an insurance co's UCR is a highly guarded secret. The only way I (as a bene's manager) was able to get it was through our insurance broker during negotions. So I would also contact your bene's manager and she what they can do for you.

Re: UCR for band??? InsuUCRrance question

I am specifically looking for BCBS in Texas. Our plan is through BCBS of Alabama, but the claims are processed in Texas.Thanks for pointing out that I forgot to include that in my original post !> >> > 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> >>

[Guest guest]

Hi and welcome to the group. If this is one of the Star Cranial

centers in Dallas or land, they are staffed with highly skilled

STARband orthotists and are wonderful at what they do. I hope this

helps. Please keep us posted.

Angie (Jenna STAR grad 2002)

Plagiocephaly , " missmailelynn " <mailelynn@...> wrote:

>

> 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

>