- 5 years ago
- Wedding: December 2011
Because I sure don’t. I have a PPO health plan through my work, and I am trying ti figure out if Nexplanton is covered on my plan. My provider is on the PPO list, I do know that, but I don’t understand the rest of this mess. Someone want to translate this? I know it shouldn’t be this confusing, but I have never really had to worry about it before but if it isn’t covered the nexplanton is like $800, and we can’t do that.
Me “Member Question:
I am trying to determine if and how much of the implantable birth control Nexplanon would be covered under my current policy or what the out of pocket cost would be. I would appreciate being directed to the correct people to determine this! Thank you.”
Insurance: “When utilizing one of our participating providers (PPO), coverage for implantable birth control performed by an M.D. in an office setting at your employer or non-employer facility is 100 percent of allowance.
*You have a pre-existing waiting period until 03/01/2014.
In order to locate participating providers in your area, please visit our Provider Finder by clicking on the ‘Find a Doctor or Hospital’ button under the “Doctors and Hospitals” tab. If you are unable to locate a specific provider, please contact us for further assistance.
We recommend utilizing one of our participating providers, which could reduce your potential out-of-pocket expense. If you choose to use a non-participating provider, the benefits could be different increasing your potential out-of-pocket expense. Please contact us if you wish to obtain your non-participating provider benefits.
This message is not a guarantee of payment. Under the terms of your health plan, payment depends on several factors, including, the member’s continued eligibility at time of service, payment of premium, amounts allowable for the service, supporting medical documentation (such as operative report or physician notes), and other requirements.”
Me:I’m confused, sorry, so if I use the PPO, it would be covered? And what is the pre-existing waiting period for?”
Insurance: Yes, if you use a PPO provider it is covered if pre-existing does not apply. A pre-existing condition is any diagnosis or treatment that was identified, received or recommended by a provider during 6 months prior to your effective date in the insurance plan. The waiting period is the number of days you must be enrolled in the plan before you receive benefits for covered services.
A certificate of credible coverage provides proof of prior health coverage (also called “credible coverage”) for you and your dependents. You may provide a copy of this certificate if you enroll in a group health plan that has a pre-existing condition waiting period to the address below.
Your previous health care benefit coverage may allow the waiting period under your new coverage to be shortened by the same amount of time you had other insurance.
The pre-existing waiting period is a provision of your contract as determined by your group. If you have any further questions as to why this is a provision of your policy, please contact your employer’s group administrator for further assistance.”
Uhhh huh? I know it must be simpler than I am making it but I am still confused!