Outpatient Physical Medicine Limits

Jan 18, 2008

  1. My Health & Income
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    Does anyone know which companies/policies include outpatient therapies/physical medicine in their policies without the low limits that seem to be most common. Most limits are below $3000 annually, except GTL and Am Nat, but I'm in La. and GTL isn't offered here.

    Any suggestions would be greatly appreciated.
     
  2. somarco
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    somarco That Medicare Expert Guy

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    It varies by state. You will have to look at plans offered in LA to glean the answer.
     
    somarco, Jan 18, 2008
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  3. Crabcake Johnny
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    No company has "limitless" outpatient therapy or outpatient therapy up to the policy max. In MD Carefirst BX has no set limitation for outpatient therapy which would lead an agent to think it's covered up to the lifetime max. That would be incorrect. Outpatient therapy is case managed and whether you get it, don't get it or how long you get it is subject to case review.
     
    Last edited: Jan 18, 2008
  4. TXINSURANCE
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    The real question is if they need this for a pre existing issue (usually why people ask) - if that is the case you will have a hard time making it through underwriting or through underwriting without rate up or restriction.

    Varies by state and company.
     
  5. Crabcake Johnny
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    Crabcake Johnny Guru

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    My father has Medicare and Plan F and they cut him off after 12 visits.
     
  6. GreenSky
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    GreenSky Guru

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    Medicare has no limit IF there is a medical need.

    My mother has been receiving PT for the past 2 years. The therapist has to be willing to "make a case". She has taken a month or so off here and there, but once new goals are set, she gets more PT.

    The real "cut off" was that the PT either thought your father had max'd out his improvement and could not justify the therapy.

    By the way, this is not an "insurance" answer but from personal experience.

    Rick
     
    GreenSky, Jan 18, 2008
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  7. Crabcake Johnny
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    Possibly - it was just a mild neck injury and he needed therapy to help regain full motion.
     
  8. My Health & Income
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    Thanks for the responses. I suppose I should have included more info.
    If an outpatient therapy is required, a short term disability for instance, the costs could run 10-20k for a 90 day period, just once or twice a week.

    GTL does include it in the max, and Assurant has a Physical Medicine Outpatient rider that increases coverage, but most of the others, except Amico, have small limits: $600-3,000. I like Assurant, and they just lowered rates here, good choice of plans and options, too, but I need something besides Amico to offer, too.

    Find a need, and fill it. LOL

    $15,000 to $50,000 would be a good alternative, but it's seldom listed until you read through every policy, and they have changed in recent years.

    If anyone has any ideas, I don't mind doing more legwork, but thought I would try to narrow it down a bit more.

    Thanks again for the help.
     
  9. salpro22
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    salpro22 Guru

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    I was told by the the regional sales manager at AIG that they just released a new accident/critical illness policy for individuals. I haven't obtained a specimen policy yet although I like what I see from the brochures.

    Essentially, you can receive accident protection up to $15,000 and CI up to $25,000. The good news about the product is that a person can obtain money above their deductible/OOPM if they choose a higher benefit. That won't exactly solve the main issue, but it could help somebody in need.

    Get somebody some accident protection and CI through Assurity or AIG depending upon your state. It's very affordable under $100,000 and its simplified issue up to that amount.

    BTW, what are they specifics of the rider you mentioned and what state does that pertain to?
     
    salpro22, Jan 18, 2008
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  10. My Health & Income
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    I like putting CI policies and the SS with $5000 with Assurant, and usually a 50k life round it out. They do have a opt benefit for some plans for Therapy services, depends on the zip for premiums. For a couple or single, rates are great, but add a few kids, and the One Ded. HSA is better than the rest. Verity Networks usually have better rates, too.

    Ex.

    State, ZIP: LA ,
    70808
    Primary: Male , 38 ,
    Preferred
    Spouse: Female , 35 ,
    Preferred
    Number of Children:
    2
    Plan Details
    Plan: OneDeductible PPO
    Network: VEHN
    Health Savings Account: HSATOOL
    Deductible: $7,500
    Coinsurance Percentage: 100%
    Coinsurance Out-of-Pocket: N/A
    Lifetime Maximum: $3,000,000
    Office Copay: None
    Initial Rate Guarantee: 24months
    Dental-Vision Discount Plan: No
    Life Insurance - Primary: $50,000
    Life Insurance - Spouse: $50,000
    Maternity Coverage No Coverage
    Amount shown includes monthly membership fee in
    Health Advocates Alliance Membership2
    Premium Details
    Primary: $83.90
    Spouse: $98.27
    Dependent Children: $92.70
    SuiteSolutions (Secure: $5,000) $37.95
    Life Insurance - Primary $12.35
    Life Insurance - Spouse $11.40
    HAA Membership Fee (monthly):2 $4.00
    Monthly Premium: 1 $340.57
    One-Time Processing Fee: $20.00
    Initial Payment: $360.57

    It's not a big issue. I like to be prepared for all possibilities, and someone had pointed out the therapy limits from a BCBS policy; wanted to make sure I had more options.


    Thanks again, guys.
     
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