Outpatient Testing BEFORE deductible?

[TXINSURANCE]

In Texas...

Aetna - will cover lab / xray with a co pay only if billed by the doctor and this is how they HANDLE claims although I can not find this IN WRITING anywhere, so I am caustious to expalin benefits as "well thats just how they do it"

Unicare - New enhanced fit covers lab / xray as well

The key with both Unicare and Aetna is same day and billed by doctor, this all comes down to coding issues and who is or is not sleeping when the claim comes in.

Of course everything is subject to pre ex or waivers if applicable and post claim review, and pulling medical records to prove pre ex.

But to answer your question - if someone will not tell me the current plan they are on .... CLICK

NEXT

 

[joshril]

In Texas...

Aetna - will cover lab / xray with a co pay only if billed by the doctor and this is how they HANDLE claims although I can not find this IN WRITING anywhere, so I am caustious to expalin benefits as "well thats just how they do it"

Unicare - New enhanced fit covers lab / xray as well

The key with both Unicare and Aetna is same day and billed by doctor, this all comes down to coding issues and who is or is not sleeping when the claim comes in.

Of course everything is subject to pre ex or waivers if applicable and post claim review, and pulling medical records to prove pre ex.

But to answer your question - if someone will not tell me the current plan they are on .... CLICK

NEXT

Yep... I don't want them as a client... just curious as the carriers that do covers these things are a bit ambiguous about what they'll actually pay.

I also cannot find anything at all in writing with Aetna, and my luck is the client I sell an Aetna plan to that I tell them about this "benefit" will not have the claim paid...

 

[TXINSURANCE]

I also cannot find anything at all in writing with Aetna, and my luck is the client I sell an Aetna plan to that I tell them about this "benefit" will not have the claim paid...

These companies CAN and DO change their internal policies all the time without notice - it is best to play it safe.

 

[LGilmore]

While curious, any time a prospect won't tell me the information I need to know to do a good job... bye...

It's one thing for them not to know, it's another to do what they're doing.

 

[joshril]

I agree... just an interesting topic for discussion.. This client is a complaint waiting to happen. They evidently want 100% of everything covered but are not willing to pay for it..

 

[TXINSURANCE]

If they will not answer ANY of your questions they are either hiding something or wasting your time , either way adios amigo...

 

[ABC]

If that is true that is a very rich benefit for a Indiviudal plan.
I would think they are paying more for that benefit and if they are asking about it then they might be high claims people. I would not want them as a client either.

In my market the indiviudal plans are covering less. I am seeing more and more economy type plans being priced right.
The traditional plans are unaffordable even with high deductibles.