Topic: How to find out allowed amount for compression garmets?

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Posted on: Oct 1, 2010 06:50PM

Posted on: Oct 1, 2010 06:50PM

angboy wrote:

I recently bought a compression bra for lymphedema and the cost was $120. The place I bought it told me they thought my insurance- federal BC/BS reimbursed $50 so I'd pay the difference. I paid $70 and they filed the claim. Meanwhil I called BC/BS and was told by someone that since I got it from a preferred provider, they'd pay 100% of the billed amount, so I thought I'd get the full $120 paid. I called BC/BS today to ask about it and was told they paid $39.50, the allowed amount. I couldn't find ANYWHERE any documentation of what the "allowed amount" is. Does anyone know how I can acess this info somewhere?

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Oct 4, 2010 07:27AM lauri wrote:

Eventually you'll get an EOB (Explanation of Benefits) that will spell it all out -- sounds like there's a maximum amount BC/BS shows as "reasonable and customary" and then they pay a percentage of that.  When I was going through treatment I went on the BC online system and left them email notes asking questions (beats sitting on the phone!) and they generally respond quickly.

From the ashes of disaster grow the roses of success Dx 3/8/2006, ILC, Left, 6cm+, Stage IIIB, metastasized to bone, Grade 2, 11/12 nodes, ER+/PR+, HER2- Dx 11/15/2021, ILC, Stage IV, metastasized to bone Hormonal Therapy 11/27/2021 Femara (letrozole) Targeted Therapy 12/2/2021 Ibrance (palbociclib) Radiation Therapy Whole breast: Breast Surgery Mastectomy: Left Chemotherapy AC + T (Taxol) Hormonal Therapy Arimidex (anastrozole)
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Oct 4, 2010 07:29AM lauri wrote:

Eventually you'll get an EOB (Explanation of Benefits) that will spell it all out -- sounds like there's a maximum amount BC/BS shows as "reasonable and customary" and then they pay a percentage of that.  When I was going through treatment I went on the BC online system and left them email notes asking questions (beats sitting on the phone!) and they generally respond quickly.

From the ashes of disaster grow the roses of success Dx 3/8/2006, ILC, Left, 6cm+, Stage IIIB, metastasized to bone, Grade 2, 11/12 nodes, ER+/PR+, HER2- Dx 11/15/2021, ILC, Stage IV, metastasized to bone Hormonal Therapy 11/27/2021 Femara (letrozole) Targeted Therapy 12/2/2021 Ibrance (palbociclib) Radiation Therapy Whole breast: Breast Surgery Mastectomy: Left Chemotherapy AC + T (Taxol) Hormonal Therapy Arimidex (anastrozole)

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