Spine and Back Disorders Benefit

[joshril]

I have a client asking about a "Spine and Back Disorders Benefit" in a Golden Rule Copay Select. It shows a $2,000 limit. Anyone know exactly how this works... I don't have a policy in front of me...

 

[STIBROKER]

 

[Crabcake Johnny]

Also, that by no means implies that someone can use up chiro visits to get some fun back adjustments. It needs to be medically necessary.

I know this well. My wife threw her back out about 4 years ago - started going to the chiro after seeing her primary. The carrier paid for two...yes two visits then denied all others as not medically necessary.

 

[joshril]

So basically this is referring to medically necessary chiropractic treatment?

Thanks, btw...

 

[Crabcake Johnny]

correct

 

[HealthGuy]

In some states however, the state mandate provides for a much more extensive spine and back benefit than what is printed in the copay select plan..State law on back coverage sometimes trumps the 'normal' limitations of the plan.

 

[TXINSURANCE]

Most individual plans have very limited coverage in this area, as almost everyone needs a back adjustment and ongoing treatment (according to them).

Also Josh if you client is "asking" that is a bad sign.

That will be a rider, rate up or decline - because if they are asking there is a reason. I hope they are not uninsured, that would be another big red flag.

 

[joshril]

Most individual plans have very limited coverage in this area, as almost everyone needs a back adjustment and ongoing treatment (according to them).

Also Josh if you client is "asking" that is a bad sign.

That will be a rider, rate up or decline - because if they are asking there is a reason. I hope they are not uninsured, that would be another big red flag.

Actually he called me while I was out and was asking how it worked... I wasn't sure of the exact wording so I thought someone here might have the info handy... He thought that there was a $2,000 limit on back surgery...
- - - - - - - - - - - - - - - - - -

Actually he called me while I was out and was asking how it worked... I wasn't sure of the exact wording so I thought someone here might have the info handy... He thought that there was a $2,000 limit on back surgery...

PS... I have a client that needs a Medigap plan written down in Houston... you know anyone?

 

[TXINSURANCE]

If you read what Sti posted it is pretty clear - however I will note OUTPATIENT being the key word.

If the back surgery was INPATIENT that statement should not apply as it is an outpatient limitation.

 

[HealthGuy]

Is inpatient simply considered an overnight stay in a hospital after a surgery? Call me stupid - here it comes.