Serious question here.......

[Beebeeblue]

I have insurance here with BCBS of FL. Recently I was told that under a new Fl law, that they are supposed to pay on "well visits" and immunizations for newborns. Face it, Im in the dr office (or will be) every 3 months now with my new one.


BUT, my insurance still doesnt cover her "well visits". Which I have to take her for to get her shots.


So how do I handle this problem?

 

[modest mouse]

perhaps the Florida Attorney general's office has a phone number or evena website which you can contact. Your Attorney General is your advocate, s/he works for you.

The FLorida Dept. of Health and Human Services (or whatever its title may be) should be of assistance as well. At the least they should be able to tell you exaclty what rights you have and what actions you can take to get what you are entitled to.

I assume you have already contacted the insurance company.

I hope you can get a better answer from someone with a more appropriate background.

 

[Lasher]

I'd need a little personal info to be able to give you a really good answer to your question, beebee. But here's a little insight.

If your coverage is under a group plan thru a self-insured group more than likely they are ERISA exempt and not subject to state mandates. If that's the case you really don't have any recourse other than complaining to your group administrator and most likely that won't do you much good.

If you wanted to PM me for some help with this that would be fine. It's probably something you really don't want to get into detail with on the board.

 

[TN_Vixen]

I'd need a little personal info to be able to give you a really good answer to your question, beebee. But here's a little insight.

If your coverage is under a group plan thru a self-insured group more than likely they are ERISA exempt and not subject to state mandates. If that's the case you really don't have any recourse other than complaining to your group administrator and most likely that won't do you much good.

If you wanted to PM me for some help with this that would be fine. It's probably something you really don't want to get into detail with on the board.

Lasher gave a bit of good advice about this, but since you said your insurance is through BCBS -then even if it is a self-funded plan, it is still administered through BCBS and therefore doesn't have the flexibility as most self-insured plans would have if they went through an independent TPA (Third Party Administrator); therefore, if your plan says it should cover "well visits" for newborns, then it should do just that, including all immunizations. If you need some help on how to research your claims or how to get those claims paid, let me know. I've been in the Insurance industry for 12 yrs.

 

[Lasher]

The thing is though, she didn't say her plan covers well visits and immunizations, she said she heard that there's a law in Florida saying that those are supposed to be covered.

The big problem is we just don't have enough info. The law may only apply to managed care plans. I'm guessing since her plan hasn't been covering well visits previously she's probably not on managed care.

I'm actually very familiar with group plans that are administered by BCBS for self-funded groups and it seems that almost universally self-funded groups cling to their ERISA pre-emption and only follow those state mandates which they choose too.

But Vixen is write, if your plan says it covers something it will cover it. What you really need to do is contact your customer service and find out what they can tell you. If they're not paying for well visits there's a reason for it. And if they're not following a state mandate there's a reason for that too. There's too much requlation in the insurance industry for anyone to just sit back and not pay claims they're contracted to pay. Sometimes it just takes a little digging to find out why.

 

[TN_Vixen]

It's been my experience that "well visits" include immunizations, at least to the extent of the first initial visits. BCBS does, however, have a "rider" that attaches to their basic plan that allows for "extended well care" and that, by definition may include future immunizations, and if they chose to not attach this "rider" to your plan (for cost reasons, most likely) then, they are paying exactly what the plan should.

Insurance, unfortunately, isn't something most people like to educate themselves about and since most Insurance Agents, Brokers and Administrators fail to take the time to make sure employees are aware of their coverage, then a lot of little costs here and there tend to fall through the cracks. Diagnostic X-Rays (when they're sent to independent labs) and Emergency Room services are two very good examples of this.

Read the fine print.

 

[oceanbaby28]

I have insurance here with BCBS of FL. Recently I was told that under a new Fl law, that they are supposed to pay on "well visits" and immunizations for newborns. Face it, Im in the dr office (or will be) every 3 months now with my new one.


BUT, my insurance still doesnt cover her "well visits". Which I have to take her for to get her shots.


So how do I handle this problem?

It may only be a matter of you're bringing it to their attention. Have you tried to call their 800 #? Your dr. or pedi might actually be another source of guidance. The office secretary I'm sure has already dealt with this type of problem and might have some suggestions for you to follow.

Good Luck and Congrats on your newborn!

 

[IrishWolfhound]

You may also want to call the FL Dept of Insurance @850-413-3100.

 

[Lasher]

LOL... You people kill me. You've got her calling the the Attorney General and the Insurance commissioner and we don't even know if she's called her customer service yet.

 

[IrishWolfhound]

Good point, Lasher. I just kind of took that one for granted, which I shouldn't have.

 

[Guest]

 

[Beebeeblue]

Hey gang. Thanks for your input.


And Emerald, I am going to take her to the HD for her shots. I can't understand why insurance doesn't cover something she has to have. I mean, it is a voluntary thing, but she has to have them for school....so why don't they pay? It's not like I enjoy watching her cry her little heart out.

 

[Jim_Henson]

Lil pennywose crying?

NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

I'll take her one time I promise

 

[Beebeeblue]

Can you be here by Friday???

 

[Jim_Henson]

Hmmm, um... Florida isnt on the way to DC is it?

 

[Beebeeblue]

Hmmm, um... Florida isnt on the way to DC is it?

*kicking some muppet ass*

NO!

 

[Jim_Henson]

I'm sorry honey... talk florida into shifting closer to Kentucky