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Thread: Insurance and SpineCor in Montreal

  1. #1
    Join Date
    Dec 2008
    Posts
    494

    Insurance and SpineCor in Montreal

    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?
    Last edited by concerned dad; 01-08-2009 at 01:09 PM.

  2. #2
    Join Date
    Aug 2007
    Posts
    388
    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.
    daughter, 12, diagnosed 8/07 with 19T/13L
    -Braced in spinecor 10/07 - 8/12 with excellent in brace correction and stable/slightly decreased out of brace curves.
    -Introduced Providence brace as adjunct at night in 11/2011 in anticipation of growth spurt. Curves still stable.
    -Currently in Boston Brace. Growth spurt is here and curves (and rotation) have increased to 23T/17L

  3. #3
    Join Date
    Dec 2008
    Posts
    494
    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.

  4. #4
    Join Date
    Aug 2007
    Posts
    388
    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.
    daughter, 12, diagnosed 8/07 with 19T/13L
    -Braced in spinecor 10/07 - 8/12 with excellent in brace correction and stable/slightly decreased out of brace curves.
    -Introduced Providence brace as adjunct at night in 11/2011 in anticipation of growth spurt. Curves still stable.
    -Currently in Boston Brace. Growth spurt is here and curves (and rotation) have increased to 23T/17L

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