Insurance Agent Forum

[joshril]

I have a client that is stating they have a plan that will pay for ultrasounds, lab-work, etc. prior to meeting a policy deductible...

I have told them that this must be some type of limited plan, because I don't know of any plans that will cover these sorts of things with a copay? (I know about the carriers that will cover labwork/testing in the doctor's office with a a $500 annual maximum and that's not what they have)

Any ideas? Does Mega offer plans that cover these sorts of things? This client won't tell me the carrier, and I really don't care about getting them as a client, but I'm curious what this plan could be?

[STIBROKER@AUSTIN.RR.COM]

Depends on how old the plan is and who it is... ......back in the day Fortis had a co~pay for out patient surgery.....bcbs also had lab and xray copays.....also.....they could be on a group plan.....how much are they paying for this plan....

Originally Posted by joshril

I have a client that is stating they have a plan that will pay for ultrasounds, lab-work, etc. prior to meeting a policy deductible...

I have told them that this must be some type of limited plan, because I don't know of any plans that will cover these sorts of things with a copay? (I know about the carriers that will cover labwork/testing in the doctor's office with a a $500 annual maximum and that's not what they have)

Any ideas? Does Mega offer plans that cover these sorts of things? This client won't tell me the carrier, and I really don't care about getting them as a client, but I'm curious what this plan could be?

[Peelerinsurance.com]

Josh, i think u are here in texas?... the new unicare and aetna offer outpat. testing b4 ded in allot of circumstances with no dolar limit. it has to be billed there. cant speak of ultrasounds...

The bcbs select blue advantage fell into that group as well

[joshril]

I think this is an older plan or something... I'm calling Aetna and Unicare to inquire about ultrasounds... Peeler, I thought the new Unicare plan had a limit on labs and what not...?

[joshril]

Also, which Aetna plan are you referring to Peeler? The "First Dollar" plans?

[joshril]

OK, this is an individual plan and it's a 45/46 year old couple paying about $400 per month with a $5000 deductible.

This can't be an old Fortis plan... the premium would be 3 times this high. This has to be a Mega type plan or something.

BlueEdge caps at $750 (I believe) and only applies to same-day stuff in the dr office... I think the premium with BlueEdge might be slightly higher anyway...

[Peelerinsurance.com]

Josh, the new unicare do not have a limit on that as per dawn holeman and unicare staff... and of course the old aetna plan had that benny on pre 7-1-08 plans and as per jackie fenton and aetna staff the new plans have that as well.. the deductible plans.. dont know about the no ded plans, cost 2 much.. and value plans i have no clue aboutas i dont sell them.

Also the aetna plans have an urgent care benny for places like care now and that is all inclusive with .... i think... 75$ co-pay... may be 50$ i cant remember

[Peelerinsurance.com]

Originally Posted by joshril

OK, this is an individual plan and it's a 45/46 year old couple paying about $400 per month with a $5000 deductible.

This can't be an old Fortis plan... the premium would be 3 times this high. This has to be a Mega type plan or something.

BlueEdge caps at $750 (I believe) and only applies to same-day stuff in the dr office... I think the premium with BlueEdge might be slightly higher anyway...

Josh, that would fit right in there with the aetna plans... also, there is a world policy i think through jim cashen and that group in ft worth that is called freedom? and it has an additional co-pay for that stuff but going off memory there may be a limit... if there is the agent probably did not tell them that... of american comunity which has a limit... bet u the agent never told them about the limit

[joshril]

Peeler... are you referring to the Aetna "PPO" series of plans? I didn't think labs and testing was covered with a copay unless it was preventative. I'm pulling an outline of coverage now...

[Peelerinsurance.com]

Josh. i just remembered, i had a client get an ultrasound and another got a colonoscopty with only the copay with aetna early this year

[Peelerinsurance.com]

Originally Posted by joshril

Peeler... are you referring to the Aetna "PPO" series of plans? I didn't think labs and testing was covered with a copay unless it was preventative. I'm pulling an outline of coverage now...

Nope josh, they are covered... even though the docs do not state as much... tex should back me up here

[joshril]

I bet the agent didn't mention the limit...

We're all on the same page that there's nothing out there that will pay if the doctor refers them to an outpatient testing facility for test though?

It looks to me like all these plans stipulate that the testing has to be done the same day in the doc's office...

[Peelerinsurance.com]

This question is why i try and work with both aetna and unicare because more times than not there is a high probibilty that the lab charges will be covered and clients hate unexpected bills... even if i beat them in the head with the bennys before we do the app... just have a chance of less complaining

[Peelerinsurance.com]

Originally Posted by joshril

I bet the agent didn't mention the limit...

We're all on the same page that there's nothing out there that will pay if the doctor refers them to an outpatient testing facility for test though?

It looks to me like all these plans stipulate that the testing has to be done the same day in the doc's office...

the uniucare chick told me labs that were referred out were co pay only... however, i dont trust that yet... until i have it happen i am keeping my big fat trap shut to clients on that

Also, cigna is here now with the exact same mgmt team as aetna had b4 so i will wait and see how they handle the claim... right now they still seem to have a problem figuring out their butt from a hole in the ground

[joshril]

Originally Posted by Peelerinsurance.com

josh. i just remembered, i had a client get an ultrasound and another got a colonoscopty with only the copay with aetna early this year

Are you serious? Covered with a copay? Is this benefit in the policy or is this a hit-and-miss thing with Aetna?

I'm trying to find a specimen Aetna contract...

[Peelerinsurance.com]

Originally Posted by joshril

Are you serious? Covered with a copay? Is this benefit in the policy or is this a hit-and-miss thing with Aetna?

I'm trying to find a specimen Aetna contract...

who knows hit an miss... or all the time... aetna just figured out their butt is diffeent from a hole in the ground...

[joshril]

This is interesting... I wonder if this is because of the way these things were billed by the doc? Specimen says Diagnostic test and X-ray that the deductible applies, but check this out:

Routine Cancer Screenings (Including, as outlined in Schedule of Charges, mammography, colorectal screenings and prostate specific antigen tests) 100% - Deductible waived...

I assume colorectal screenings would include a colonoscopy, but this is fairly ambiguous wording...

[Peelerinsurance.com]

Yep... i can only go off of experience and aetna has always paid lab and xray with copay when done there or billed there... i had about 200 clients on ther at one point and no one EVER calle dto bitch me out about what i told them

[joshril]

Thanks for the feedback Peeler!

[STIBROKER@AUSTIN.RR.COM]

Originally Posted by joshril

OK, this is an individual plan and it's a 45/46 year old couple paying about $400 per month with a $5000 deductible.

Do you have a better rate to sell them.......