Federal insurance that pays out of network?

[Anonymous]

Is there anyone with one of the Federal health plans that actually gets reimbursed for out of network care? DC's psychiatrist and therapist, both of whom we like, do not take any insurance (surprise, surprise). Aetna won't reimburse us as they're out of network. Now that open season is approaching, I'm trying to figure out if there is any insurance that may cover a decent part of those costs next year. I'm not optimistic but figured I'd ask those in this forum in case someone has figured this out or has experience to share. TIA

[Anonymous]

BCBS Standard covers a tiny bit out-of-network after meeting the annual max. I would absolutely not call it as "covering a decent part of costs" though.

[Anonymous]

We have NALC High option. I have had them for years. They are really a Cigna PPO despite the odd name.

They cover 60% OON after $150 deductible.

[Anonymous]

We have BCBS standard. I've been able to get a psychiatrist in network. They cover about 40% of DS's therapy (out of network psychologist) after we've met our annual deductible.

[Anonymous]

Who is that in network psychiatrist?

[Anonymous]

Anonymous wrote:We have NALC High option. I have had them for years. They are really a Cigna PPO despite the odd name.

They cover 60% OON after $150 deductible.

+1 on NALC.

[Anonymous]

GEHA standard (united healthcare) covers 65% of the allowable amount (you can be balance billed for the rest.) There isn't a separate oon deductible. The regular one is $750 for self+family. The annual OON (auth. amount) out of pocket max is $7k

But.... GEHA is a customer service toothache. Preauth is needed for all imaging and PT, labs are only covered 100% if drawn at Labcorp or quest.

I like the OON coverage (and lower premiums), but there are areas they are seriously in need of improvement.

[Anonymous]

Anonymous wrote:Who is that in network psychiatrist?

If you are referring to my post above, we had Dr. Sady.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is that in network psychiatrist?

If you are referring to my post above, we had Dr. Sady.

Oops, disregard that. Not my post above.

[Anonymous]

Dr iqbal at the wellness connection in south riding is in network with bcbs.

Dominion ctr for behavioral health services, also in south riding, used to have a psychiatrist (and in network) but I don't know if they still do.

[Anonymous]

South riding va in loudoun county

[Anonymous]

Apwu

[Anonymous]

Anonymous wrote:GEHA standard (united healthcare) covers 65% of the allowable amount (you can be balance billed for the rest.) There isn't a separate oon deductible. The regular one is $750 for self+family. The annual OON (auth. amount) out of pocket max is $7k

But.... GEHA is a customer service toothache. Preauth is needed for all imaging and PT, labs are only covered 100% if drawn at Labcorp or quest.

I like the OON coverage (and lower premiums), but there are areas they are seriously in need of improvement.

GEHA high. Definitely. We are OON for four family members on MH care with them. I did a lot of research and calling different insurance companies companies on just this issue. 80% reimbursement OON, with no limit on things like therapy. No preauthorization. $7k out of pocket cap. They also have higher than average reimbursement rates-- for example $150/ hour this year for therapy. I believe it is around $180 half/hour for psychiatrist. I have never had an invoice questioned, and they process and reimburse quickly.

GEHA high is expensive ($263 per pay period for self plus family)-- but if you do a lot of OON care, you come out way ahead.

[Anonymous]

Check out BCBS