FL blue PPO question

[Chazm]

I have an individual FL Blue PPO pre-ACA plan. I went to a chiropractor that does not take insurance and I paid for 25 visits out of pocket.
After 12 visits, I asked the office for a statement showing what I’ve paid so far and I submitted a claim with FL blue.
I’ve checked my plan out a few times this week and it’s a plan that pays up to $50 for a specialist out of network with no deductible for office visits in or OON.

Fl Blue sent me a check for $50 claiming that each visit of $51 only allowed a payment of $31.75 and that I had to meet my deductible.
I’m going to call FL blue next week but is this just an appeal? What do I need to ask?

 

[Yagents]

On those old policies, they didn't have good chiro coverage. (never sold FB though)
I would be surprised if it WASN'T subject to the deductible OON even if a covered benefit.
Wonder if they consider a chiropractor as a specialist?
The allowed amount is probably the Usual and Customary amount since he doesn't take insurance or FB.

 

[Chazm]

On those old policies, they didn't have good chiro coverage. (never sold FB though)
I would be surprised if it WASN'T subject to the deductible OON even if a covered benefit.
Wonder if they consider a chiropractor as a specialist?
The allowed amount is probably the Usual and Customary amount since he doesn't take insurance or FB.

Thanks

Unless they changed my policy in August, I’ve used my plan OON for a chiro many times. But, that chiro would bill it themselves. There was no DED.

I’m going to call them on Monday and start with, “does my plan have a DED on OON doctor visits? If not, is a chiro a specialist”?