Sigh, another insurance related question for you all...
Last friday, I was on the phone with 3 different reps at BCBS FL (my policy is HMO). One person said I need a referral from my PCP and the ins. will look over the paperwork, the other rep said we have to pay oop since my policy doesn't cover oop. I said then what is the purpose of Gap Exception referral?? He wasn't sure.
Now after that, I went and met dh, sat down with a rep from BCBS who came to meet with employees to discuss benefits. She was willing to help but didn't know much about Gap EX. Now I went to my doc's office near there on the way home, the office coorinator was saying that (after more than an hour waiting in the lobby with 2 kids while she calls around to get info) they can't do anything for me since the ins. is not going to accept any Gap Exception because it is not needed, my policy is not covered for out of network so no need to send a referral, they are not going to pay, period!
Now, my frustration is that why so many different stories from different people?? We were told one thing and try to get whatever is required and now one of the parties are saying different story. Now my Q is has anyone got paid anything when your policy said (which I didn't find any of this exception) no coverage for OON provider by having a gap exception from your PCP? Is this possible or not?
I can't have this baby obviously before this is settled but with this stress I am afraid that I might actually go earlier than 38th week! (only 3 weeks to go)...
Please anyone experience similar situation and tell me how it got resolved???
Last friday, I was on the phone with 3 different reps at BCBS FL (my policy is HMO). One person said I need a referral from my PCP and the ins. will look over the paperwork, the other rep said we have to pay oop since my policy doesn't cover oop. I said then what is the purpose of Gap Exception referral?? He wasn't sure.
Now after that, I went and met dh, sat down with a rep from BCBS who came to meet with employees to discuss benefits. She was willing to help but didn't know much about Gap EX. Now I went to my doc's office near there on the way home, the office coorinator was saying that (after more than an hour waiting in the lobby with 2 kids while she calls around to get info) they can't do anything for me since the ins. is not going to accept any Gap Exception because it is not needed, my policy is not covered for out of network so no need to send a referral, they are not going to pay, period!
Now, my frustration is that why so many different stories from different people?? We were told one thing and try to get whatever is required and now one of the parties are saying different story. Now my Q is has anyone got paid anything when your policy said (which I didn't find any of this exception) no coverage for OON provider by having a gap exception from your PCP? Is this possible or not?
I can't have this baby obviously before this is settled but with this stress I am afraid that I might actually go earlier than 38th week! (only 3 weeks to go)...
Please anyone experience similar situation and tell me how it got resolved???
: ~ our co-pays changed & I wanted to get a gap coverage for her because the cost doubled....well now they are saying that only MW"s who work under a DR are covered...no real answer as to why the change...other then something changed in our plan on the 1st (but she can't be sure if it did)
