FFC and PPO Insurance

Discussion in 'Fibromyalgia Main Forum' started by jane32, Nov 14, 2005.

  1. jane32

    jane32 New Member

    Did anyone's insurance count the centers as being out of network? They would cover 80% of my bills once I hit my $2500 deductable which I will just barely hit by the end of the year and then of course it has to start all over. I was just wondering if anyonw was able to make it in network after talking with their insurance company. I have BCBS PPO. Supposedly really good insurance but I hate this out of network deal:(
  2. LISALOO

    LISALOO New Member

    And yes they concidered it out of network. They paid 80% of my visits and blood tests, and the iv.
  3. goaska29

    goaska29 New Member

    I just wanted to chime in that I also have BCBS ppo and it also covered 80% of my FFC bills. I have also met my deductible for the year.

    The administrator at the FFC told me that they have very good luck with ppo's covering a lot of their patients' expenses. I'm just glad I "happened" to have chosen a ppo plan before I became ill.
  4. ldbgcoleman

    ldbgcoleman New Member

    My plkan pays 60% out of network and covered everything but the Ivs and supplements not great but better than nothing! L
  5. abbylee

    abbylee New Member

    I've not gone to an FFC, but I take Xyrem from an out-of-network pharmacy. Since the FDA will only let one pharmacy in the US stock this drug, I begged and begged and finally BCBS agreed to pay 80% instead of 60%. Since the drug costs $526 every 22 days, this is a big difference.

    If you have a problem go to HR. Employers are given a choice of which insurance policies they offer their employees AND they usually want their employees to be happy. If you find that BCBS won't agree to help you, go to HR and ask them to contact BCBS and have them make an exception. You shouldn't have a problem after that.

    abbylee PS - My out-of-pocket max is $3000 and I reached it last month so for the rest of the year all of my meds are covered completely. This is even better news as with everything included I pay about 250.00 a month (or maybe a little more) for meds.
  6. browneyes259

    browneyes259 New Member

    Since I just started my visits (I've had two) I am still fighting them to pay anything. I am fighting for in-network, saying they don't provide a FMS/CFS specialist in-network so it's not my fault.

    Hoping I can just get out-of-network in the end. Who knows? What fun would insurance be w/o having to fight for every penny!

    :):)
    Jen
  7. jane32

    jane32 New Member

    Thanks. Thats a good idea to fight with them as they don't have an in network specialist. I met my other deductable early as I always try to stay in network but now it didn't matter since I have to pay it anyways.
  8. jane32

    jane32 New Member

    Thanks mine actually pays better in network and I already reached that deductable. I have to now pay $2500 in order for them to pay 80%.