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

Forum Index » Kids With Special Needs and Disabilities

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

Subject:

Emoticons





More smilies

Text Color: Font: Close Marks

[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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 [b]Non-Contracting Physicians or Non-Contracting Providers[/b], unless written prior authorization is specifically obtained from CareFirst BlueChoice." [/quote]

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

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?

[/quote]

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. [/quote]

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.[/quote]

Options

	Disable HTML in this message
	Disable BB Code in this message
	Disable smilies in this message

Review message

Search Recent Topics Hottest Topics