What to expect? INS Coverage?

[vermontmoms]

We have our initial appointment w/Dr. L in a few weeks for our twin boys. I was wondering if anyone could tell me what to expect? What will she do, review, etc.? We were told that we would be there from about 1-5pm with both boys? Will they do any testing on them during this time or is it all just history collection, etc? If they will do testing, what will be done?

 

Now about payment...I know the person I spoke with in the office told me the upfront cost of this appointment for the boys but was wondering if anyone got this fee reimbursed from their insurance? If yes, who was your insurance company and what paperwork did you file to get reimbursed? Did Dr. L’s office provide you with any of this paperwork?

 

Thanks for any info on this appointment!!!

Jen

[NancyD]

For us, most of it was history collection and a brief examination and talking with DD. The rest was Dr. L giving her recommendations. We paid up front and Dr. L's office manager submitted the proper form to insurance -- although this had to be done again with lots of follow up by me because our insurance company, Harvard Pilgrim Health, said they could not find the claim and then they needed additional info from Dr. L's office. We received back all but the $20 co-pay since she is part of our PPO network.

[vermontmoms]

For us, most of it was history collection and a brief examination and talking with DD. The rest was Dr. L giving her recommendations. We paid up front and Dr. L's office manager submitted the proper form to insurance -- although this had to be done again with lots of follow up by me because our insurance company, Harvard Pilgrim Health, said they could not find the claim and then they needed additional info from Dr. L's office. We received back all but the $20 co-pay since she is part of our PPO network.

 

That is great news...we are with Anthem BC/BS and hopefully we will get the same coverage as you and get most of it back. Did anyone have BC/BS go to Dr. L? Were you able to get reimbursement?

Thanks!

Jen

[peglem]

My daughter is an unusual case, so I think "normal" pandas would have a different experience. But we got pre-approval for coverage from our insurance (UHC)because our daughter was referred by a local specialist. I filed the paperwork myself and we were reimbursed everything but the $35 copay. I probably could have gotten the $35 reimbursed by her secondary insurance if I'd really fought for it. They denied it on pre-approval.

[eljomom]

We are Anthem PPO....but very high out-of-network deductible, which she is for us (out-of-network). So for us, we pay ALL and get NO reimbursement I assume with a good PPO, then once you meet your deductible, you will get out-of-network benefits. We switched insurance right before my daughter tanked with this....but our old Anthem, we would have paid $300 out-of-network deductible and then been reimbursed. I think it all depends on deductible..