Looking for a referral to an OT for SI issues that is a BCBS Federal Insurance Plan Provider.

[Anonymous]

Hello,

I'm looking for a referral to an OT for SI issues that is a BCBS Federal Insurance Plan Provider. Thank You.

[Anonymous]

Where are you located?

[Anonymous]

Montgomery County but we will travel if we can find a quality provider who accepts our insurance.

[Anonymous]

Have you tried their on line provider search? You might get more responses if you search and see who takes the insurance, then ask what people know about the person.

I know the place we go (SkillBuilders) does not take insurance. We pay, then submit to BCBS, but we're standard option, not basic option so we can do that.

[Anonymous]

Not OP but follow up question: If we do OT for SI issues at an out of plan place, what does BCBS Standard Option cover?

[Anonymous]

We have BCBS Standard. They say they will cover 70% of OT (up to a certain number of visits) for an out of network thereapist (I'm the SKillbuilders poster). I think you have to be careful of the diagnosis to make sure it will be covered. We have submitted, but I'm not sure if we've received any checks yet. We did receive payments for another OT we saw before we moved here and I believe it was 70% (also through BCBS standard) DD just started therapy here in December.

[Anonymous]

OP, we have BCBS FEP standard and tried for the longest time to stay in-network, but had a hard time getting off wait lists at hospitals, etc.

Our children now see a non-participating OT who bills $110 an hour. I recently submitted our invoices for 2009, and BCBS allowed $110 an hour. With our 30% co-payment, our out-of-pocket cost was $33 per session. That's only $13 per session more than we would have paid had we waited for an in-network provider. (Either way, we have a 75 session limit per year, but we never get close to reaching that limit.)

You might want to consider an out-of-network provider. Go for one visit, submit the invoice immediately, and wait a few weeks to see what your out-of-pockets costs are.

[Anonymous]

Anonymous wrote:OP, we have BCBS FEP standard and tried for the longest time to stay in-network, but had a hard time getting off wait lists at hospitals, etc.

Our children now see a non-participating OT who bills $110 an hour. I recently submitted our invoices for 2009, and BCBS allowed $110 an hour. With our 30% co-payment, our out-of-pocket cost was $33 per session. That's only $13 per session more than we would have paid had we waited for an in-network provider. (Either way, we have a 75 session limit per year, but we never get close to reaching that limit.)

You might want to consider an out-of-network provider. Go for one visit, submit the invoice immediately, and wait a few weeks to see what your out-of-pockets costs are.

I have BCBS Standard FEP and out of my $110 charge, they are paying like $9. They mark it down (the plan allowance) to $33 and pay 70% of that, or $23.27 (off of my latest EOB). So I end up paying about $90 per session. I'm going to call them if they are not saying the plan allowance is $33 for yours like they are for mine.

[Anonymous]

Kids' Therapy Works in SS used to take insurance, might be worth checking. I was told to see only Linda Nolan, the owner, as some of the OTs are not certified.

Be careful with BC, ours reimburses differently depending on the code for OON. One code was 50% and one was 70%. Generally our OT billed 50% of each session to each code. The first session which was kind of an eval, was activities comprised mainly of the 70% reimbursed category, when we started getting bigger bills later we were surprised. Ask the OTs what codes they use and call BC so you don't get unhappy surprises.

[Anonymous]

Try Early Intervention Services, Deb Goldfarb. I have BCBS, carefirst and they are reimbursing us almost 100%. My son is seeing her for muscle tone issues and not for Sensory issues, but it is worth a try. She is in Rockville and we have been very happy with her.