Reply to Carefirst out of network benefits suck / allowable charges racket

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]balance billing / allowable charges... horrible concepts. buyer beware.

We have out of network benefits that kick in once we meet the deductible for out of network of $1,600 per individual. (we pay that, then the benefits kick in).

Example: Someone sees a provider weekly - for a year - that charges $190 per hour.

However, only $77.40 (40.7%) of that $190 is "allowed" by Carefirst.  Meaning only $77.40 gets applied to the deductible amount. Good luck finding a therapist in the DMV for $77.40/hour.

So now, instead of needing to fork out $1,600 before getting benefits, I have to pay out $3,928 to the provider to fulfill my $1,600 deductible. (Scam one)

Now, by halfway through the year, I'm getting benefits. But wait, there's a $50 copay per visit (which I knew about but figured a greater percentage of the charges would be paid) (Scam two is only an issue once you realize you get so little back to start with)

So, for each $190 charged, they "allow" $77.40, then knock that down by $50 to give me a check for $27.40 per visit.

For a full year, I would pay $9,500 for 50 weekly visits (not saying we do this, but for illustration purposes). On the 21st visit I would start getting some benefits. By the end of the year, I would have 29 visits "covered" and receive a check for $794.60, about 8% of my total expenditures FOR THE YEAR.

To get this money I HAVE TO SUBMIT TONS of paperwork and SUPERBILLS,

I took some time to figure out how little payback there was for this. It's not fair to the average person at all.[/quote]

Ask them to find you someone in network. If it's for something they say they cover and they can't find anyone in network, appeal to get more covered. [b]If you're in MD complain to the state insurance commissioner [/quote][/b]

oh like filing a letter with the insurance commissioner in MD is going to do anything.[/quote]

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