Reply to How to calculate potential cost of neuro-psych or ed-psych evaluation and whether it's worth changing insurance

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[quote=Transplant_1]Hello all, I currently have health insurance but it covers only in network care (BCBS Federal Employee Program Basic).  But it appears most providers providing neuropsych and edpsych testing are out of network.

I'm considering getting insurance that provides some coverage for out of network care (BCBS FEP Standard), but it has a higher premium, and a deductible.  For 2024, Standard would be more by about $3,560 more than Basic (deductible plus the difference in premium. There are a few other differences, but I think the rest are very minor. This is all public info on the OPM website.)  I'm trying to calculate whether it's worth the trade off.

Under Standard plan, I will pay 35% of the Plan allowance (and whatever amount the provider charges above the allowance) and BCBS will pay 65%.  I' have to "use up" a large enough Plan allowance so that 65% of it would at least equal $3,560, to be worth the trade off.  So, I'd have to use up at least $5,500 worth of medical care Plan allowance out-of-network to be worth the gtrade off the $3,560 in increased premium and deductible.

So, I called the insurance company and asked "what is the plan allowance for neuropsych or edpsych testing" but they said it all depends on the code, but they won't tell me what the code is.

I google a bit to see if I could figure out the code, but there appears to be several, for different types of activities.  This is one source I found (https://www.apaservices.org/practice/reimbursement/health-codes/testing/neuropsychological-testing.pdf).

Also, how much to providers out of network tend to charge above the plan allowance?

I would be utterly indebted to anyone that could help me think this through.

Thank you.[/quote]

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