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concerned dad
01-08-2009, 01:05 PM
Does anyone here have any advice concerning getting reimbursement for services rendered in Montreal?
I do have out of network coverage, but I see my insurance says:
Your provider must call the toll-free number listed on your ID card to precertify designated services.
I dont imagine the Montreal doctors have much experience dealing with US insurance companies. I was planning on paying out of pocket and then submitting a claim to see what may be covered. But it also looks like I will be penalized 50% of any covered charges if I dont get them pre-certified.
Perhaps this is something I can ask our local (in network) pediatrician to address?

jillw
01-08-2009, 11:04 PM
Is a brace one of the designated services that require precertification? Obviously every plan is different, but for my plan precertification was NOT required for a brace (whereas it is required for certain other procedures). I called my insurance directly to see if precertification was required for bracing in general. You could call and provide them the code, which is L1005.

I don't know how much experience they have in Montreal with those types of US insurance issues. However, I would suggest calling them in advance if pre-cert is necessary.

In our case we have blue cross/blue shield (and even within blue cross, coverage varies widely depending on state and the sponsoring employer). We did get out-of-network coverage without much trouble (to my surprise) - although strangely, the brace itself wasn't subject to deductibles and was reimbursed 100% (whereas doctors, xrays, etc subject to the higher deductibel and lower reimbursement rate associated with out of network). Good luck with the insurance issue and good luck to your daughter with spinecor itself.

concerned dad
01-09-2009, 01:27 PM
Thank you very much JillW

I called my insurance company and supplied that code (L1005) which is specific for the SpineCor.
I was initially told that I was covered for it but only in the US. They said any services out of the country was covered on an emergency basis only.

After speaking with 3 people, I found a supervisor who told me I was indeed covered (60% after deductible) no matter where I go for treatment. That code was key.

I will, of course, have to pay out of pocket in Montreal and then submit a claim for reimbursement.

Obviously, there are a zillion different insurance plans, mine happens to be CIGNA. Had I not had Out of network coverage, I would have been sunk.

jillw
01-12-2009, 10:48 AM
Glad to hear you got some answers. I am so thankful for our out of network coverage! (for a few years the only plan available to us that was good for the area we lived in did NOT provide out of network coverage and I always worried about what would happen if we needed a real specialist due to some condition. Fortunately a year or so before my daughter's diagnosis they added plans so we could choose a plan with out of network benefits. We ended up using that sooner than I thought!)

When do you go up? Do you have to travel far? (don't forget passports for the adults and passports or birth certificates for the kids) Please let us know on the spinecore thread how it goes.