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Special Needs
Obsession
member
does your insurance allow you to "shop around" for a provider?
Obsession
member
I'm not getting warm fuzzies from the OT/PT place we're going to right now for a lot of different reasons. I can go through them if you need me to but most of all I'm just not getting a good vibe. Plus it is ridiculously hard to get an appointment and hard for us to get to.
I found another place right around the corner from where I live. When I called to make an appt. they said they would still have to do an evaluation even with the paperwork from the other place. Will insurance pay for an evaluation when we've already had one?
I'm sure I need to call them and ask them but what is your experience with switching providers?
This discussion has been closed.
Re: does your insurance allow you to "shop around" for a provider?
I'm on TriCare insurance (military family here). I have to get a referral for any specialist. If I've ever gone to a second specialist, I've usually done it as a 2nd opinion and it has typically been covered (however I think I have only done this once or twice).
Most of the time when I have needed new referrals/authorizations for a similar provider it was because I was moving states (during a deployment) which also resulted in moving insurance regions too.
Your best bet is to call your insurance company and I would explain to them that you are wanting a 2nd opinion.
So back to original question...what was your experience with this?
We used to have Anthem and as annoying as they were with not cover MRIs etc, they never seemed to have a problem with our 2nd opinions. (Sometimes 3rd)
I can't say for sure about our new insurance because we've only had them a month and they have yet to pay a single claim.
I know in our summary of benefits it specifically says something about 2nd and 3rd opinions.
We did an eval through the county (which billed the insurance) and also a private eval for Peyton's outpatient PT. They covered both from what I remember. BUT I remember the therapy center saying if we were doing PT through the county that we couldn't do it there as well, that the insurance wouldn't cover both.
I know you want to hear personal experiences, but honestly, what ultimately matters is what your specific policy covers. 10 of us can have the same insurance company but every policy can be different (we often have posters with the same insurance company that have VERY different coverage).
If I were in your position, I would ask for the billing code that the therapist wants to use for the evaluation and call your insurance company to ask if it will be covered. I have found that being armed with both the diagnostic AND treatment code before calling your insurance provider is the best way to find out what your policy covers.
Good luck!
huh? me confuzzled.
Our insurance is a PPO. We don't have to have referrals etc. We just go to the dr and it is covered.We get multiple hearing tests. One from ENT and one from our audiologist. Insurance has never not paid for one test because we did another somewhere else.
I think everyone's insurance coverage is going to be different, so what happens to others may not really inform you of much in regards to your own situation.
I'm reading the first sentence as really rude. I doubt that was your intent but for some reason that is how it is coming off to me.
As for the second sentence, ultimately you need to call them to find out. We don't know what insurance you have and even if it is the same company it will vary from company to company/policy holder to policy holder. No one here is ultimately going to be able to tell you if they are going to cover a 2nd opinion appointment and a 2nd evaluation. I agree with the pp to get the billing code they would use to see if there is a limit on how frequently it can be used, if it is even covered, etc.
Good luck!
Sometimes I feel like when I ask a question on here I don't get an answer.
This is a perfect example. I stated I knew I needed to talk to my insurance yet that was everyone's response. I wanted to hear other people's stories. So to those who shared those stories thank you!
I'm sure I need to call them and ask them but what is your experience with switching providers?
(please read this in a non-snarky tone of voice)
Those were your questions. I think the people who had switched providers and were online today answered what they could based on their experience. I switched providers for therapy, but it had no bearing on insurance since it was through EI. Maybe you will get more answers this weekend. SN moms are busy and are not online all the time.
Just because the answers you got up to this point are not exactly what you were looking for does not mean they aren't coming from a place of trying to help you out. If you are going to feel put off so easily, people may think twice about helping you in the future. JMO.
Sorry if I came across as shitty. I probably did have a chip on my shoulder but it wasn't productive and came out in the wrong forum.
I am probably a little too sensitive when it comes to the way people address things on these boards. My husband tells me it is all semantics but I really think the way a response is worded matters.
For example, if someone asks where they can find something, I think it sounds harsh to say "well why did you ask your pedi?" I see that as snarky. Obviously the person hadn't thought to ask their pedi otherwise they wouldn't have asked the question here. I think a better answer would be "I bet your pedi would be a good resource for that type of question."
But that is my problem not this boards! Sorry - I need to grow thicker skin.