Please help me not screw up in asking about coverage for neuropsych eval

[Anonymous]

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

Did your pediatrician make a referral or did you just call KKI for the appointment? I have carefirst federal and suspect ADHD for my 5 year old.

[Anonymous]

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

What was your out of pocket cost?

[Anonymous]

One other thing to add is that our neuropsychologist said to submit it to CareFirst and that if they deny it, to submit it again through the appeals process and they will pay for some of it (like 1/2), which is better than nothing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

Did your pediatrician make a referral or did you just call KKI for the appointment? I have carefirst federal and suspect ADHD for my 5 year old.

You can just call.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. One follow-up. My carefirst contract says "Except for Emergency Services, Urgent Care, and follow-up care after emergency surgery, benefits will not be provided for any service(s) provided to a Member by Non-Contracting Physicians or Non-Contracting Providers, unless written prior authorization is specifically obtained from CareFirst BlueChoice."

Sounds to me like you need prior authorization for out-of-network or "non-preferred" Providers?

Agree.

If you had this testing done with an in-network hospital (e.g. Children's or KKI) then whatever benefit they give you for that code would be covered.

If you want to go out of network or to an insurer who doesn't take insurance at all, you need prior authorization or they may not cover anything, regardless of the treatment code. So if you lived somewhere with no in-network providers to perform a service, they may grant permission for you to use a portion of the benefit with an out of network provider. But in this case, I think it's unlikely.

Have you used out of network providers for any other health care service for any family members with this insurance?

OP here. Has anyone gone through the process of seeking preauthorizarion for neuropsych eval from an out of network provider? Any advice? Again, just like my OP post, anything I should say/not say? Do insurers usually have a form they have someone fill out in seeking preauthorizarion? Thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

Did your pediatrician make a referral or did you just call KKI for the appointment? I have carefirst federal and suspect ADHD for my 5 year old.

I think I just called Kennedy Krieger and made the appointment. They were in network. I paid very little, like a $25 co-pay.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. One follow-up. My carefirst contract says "Except for Emergency Services, Urgent Care, and follow-up care after emergency surgery, benefits will not be provided for any service(s) provided to a Member by Non-Contracting Physicians or Non-Contracting Providers, unless written prior authorization is specifically obtained from CareFirst BlueChoice."

Sounds to me like you need prior authorization for out-of-network or "non-preferred" Providers?

Agree.

If you had this testing done with an in-network hospital (e.g. Children's or KKI) then whatever benefit they give you for that code would be covered.

If you want to go out of network or to an insurer who doesn't take insurance at all, you need prior authorization or they may not cover anything, regardless of the treatment code. So if you lived somewhere with no in-network providers to perform a service, they may grant permission for you to use a portion of the benefit with an out of network provider. But in this case, I think it's unlikely.

Have you used out of network providers for any other health care service for any family members with this insurance?

OP here. Has anyone gone through the process of seeking preauthorizarion for neuropsych eval from an out of network provider? Any advice? Again, just like my OP post, anything I should say/not say? Do insurers usually have a form they have someone fill out in seeking preauthorizarion? Thanks.

Usually they ask you to submit a letter.

The decision will turn on whether or not you have in-network options -- basically why they should pay 3-4x more for hte same service from the provider you chose vs their in-network option.

Assuming you live in the DC metro area, this is going to be an uphill climb because Carefirst has well regarded in-network providers for this.

[Anonymous]

I believe "BlueChoice" is an HMO plan, which means you won't be covered at all for out of network. I suspect it will be difficult to get pre-auth for this type of thing, but hopefully I am wrong.

[Anonymous]

Anonymous wrote:I believe "BlueChoice" is an HMO plan, which means you won't be covered at all for out of network. I suspect it will be difficult to get pre-auth for this type of thing, but hopefully I am wrong.

OP here. It's a PPO which enables me to go Out of network. But thanks for suggesting that I check.

[Anonymous]

We decided to go in network for testing. I called and coverage will depend on what tests the in-network psychologist decides on and then if insurance covers them - evidently they only cover some not all? This is with Aetna. We figure we will need any money we save for what's down the road.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

Did your pediatrician make a referral or did you just call KKI for the appointment? I have carefirst federal and suspect ADHD for my 5 year old.

I think I just called Kennedy Krieger and made the appointment. They were in network. I paid very little, like a $25 co-pay.

I'm the other PP who used KKI. I just called and made the appointment. I asked them if they are a participating provider, and if they would make sure it's covered before our appointment. They did that. I think I had a copay (honestly don't remember, but if we did, it might have been $40) Otherwise, I think it was completely covered. Knock on wood. No bill has come in the mail!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:op, we have carefirst (blue cross blue shield FEP)
and KKI is a participating provider, so we had it covered there without any finagling.

Same for me/us. Concern was that child might have mental health issues or ADHD.... no concern about academic issues.

Did your pediatrician make a referral or did you just call KKI for the appointment? I have carefirst federal and suspect ADHD for my 5 year old.

I think I just called Kennedy Krieger and made the appointment. They were in network. I paid very little, like a $25 co-pay.

I'm the other PP who used KKI. I just called and made the appointment. I asked them if they are a participating provider, and if they would make sure it's covered before our appointment. They did that. I think I had a copay (honestly don't remember, but if we did, it might have been $40) Otherwise, I think it was completely covered. Knock on wood. No bill has come in the mail!

How long did it take after your initial appointment to get the testing done and final report?