Sunday, November 7, 2010

Changing Insurance policy

Ugg... one of the banes of my existence is fighting with my insurance company. Our insurance is a little strange. We have Blue Cross Personal Choice which generally speaking I like. It isn't the best but it is better than most. Because Brian works at a hospital we get 90 to 100% coverage if we use his hospital. Last year the insurance added CHOP (and a couple others) to his "network" so we get 90% coverage at CHOP. The problem is EVERY SINGLE TIME the insurance company pays out CHOP they only pay out at 70% (which is the out of network charge) and I have to appeal the claim. I have gotten pretty good at it and now have templates for all different circumstances.

We are doing our nexts years enrollment and the insurance company has changed the wording. It doesn't sound like much but I have a feeling it is going to cost us. Instead of saying "***Included in this tier of coverage is also CHOP, Virtua, etc., etc." to "***Included in this tier are the facility charges (not physician charges) at CHOP...". To the lay person (who doesn't have a medically needy child) this might not ring any bells. For me it raised all my red flags. It is almost like they gave themselves an out to NOT cover us at the same rate. I have a feeling this year I will be sending twice as many appeal letters.

As an aside, I know there a couple of readers who are expecting children with RS. One very important piece of advice I have to you is GET TO KNOW YOUR INSURANCE POLICY! Know your coverage. Know what your deductible is. Know what doctors are covered at a higher rate than others. Having a child with RS is more expensive than a typical child so know the ins and outs of your policy. Also make sure to look into deducting your medical expenses on your taxes. We have every year since Abby was born and although it isn't a lot it does help.

No comments:

Post a Comment