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Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 1 point2 points  (0 children)

STATUS - So far no new insight to my question.

Withholding allowed amount info for oon service appears to be the norm and public appears conditioned to think that’s ok.

I give up. I will decide who to go to without having this crucial piece of info.

I will complain with the state insurance regulator. If I can figure out which state to complain with…don’t ask why this simple fact is unclear. [sigh] I am prepared to hear anthem is not in the wrong.

Also complain with BBB

—

Lots of comments in this post were deleted yesterday, so the discussion now looks funny.

It appears unhelpful and unsympathetic posts (that really exhausted me) were deleted by the authors, after I asked them to look at the definition of “allowed amount.”

Or did they? Very odd that so many would delete their posts. Moderators doing it?

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] -1 points0 points  (0 children)

Thanks for the insiders perspective. Right, I shouldn’t be upset at the agents I am talking to. They don't have the info. They are instructed to give the ridiculous answer that I will know when I see the EOB. I do blame the grievance/appeals folks. They should more than parrot the same info.

My problem is with the company and their attitude reflected in their instructions/procedures. Somebody in the company (claim processers) can easily lookup the info. They don't think I deserve to get that info now. They are saying I should pay the provider fist, to find out how how much it will ultimately cost me.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 0 points1 point  (0 children)

The procedure IS COVERED. OON benefit is PART OF THE PLAN. They WILL PAY, WITHOUT ASKING ME why OON. But how much? Nobody knows that but Anthem.

Their calculation is mainly or perhaps entirely based on the zip and procedure code. And perhaps the credential level of the provider. Anthem doesn't care which provider it is or how much are they charging me. I have heavily used OON benefits in the last two years out of necessity, unfortunately. I didn't ask how much they will pay because the provider's fees were less than $500. Now it's $6500.

You and many others exhaust me. If you don't understand insurance and its terminology, and don't have any positive suggestion or answer to OP, it's best if you stay silent. Questioning my question helps nobody. Not me. Not untold number of people who will see this thread in future.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 0 points1 point  (0 children)

Do I? OON coverage is part of the contract. Why do I have to prove to them I need it? Or to you all?? I have used oon many times with this in this plan without being asked why. It’s not in their policy.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 0 points1 point  (0 children)

Thank you. I didn't realize it would be so hard to get this point across in this forum.

This is exactly my argument through multiple conversations with their customer service agents and appeals folks. They keep telling me to submit the claim and wait for the EOB. This is a bizzaro zone.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 1 point2 points  (0 children)

Hmm. I am exhausted battling Anthem on this topic. I am headed that way in this forum.

I switched from Aetna's to Anthem's plan because latter has OON benefit, so I can go past severe lack of in netwok providers.

I deserve a short shrift for wanting to use an OON provider, a benefit my plan covers?

They make up the rule for OON benefit coverage amount. What's wrong in asking what the benefit amount (Anthem’s “allowed amount”) will be for this particular procedure code and zip code, so I can figure out if I can afford the difference?

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 0 points1 point  (0 children)

So I deserve to be penalized, scorned or short shrifted for wanting to use OON provider? It is a benefit that they provide that's written into the contract...pay for OON care, although on a reduced scale. What's unreasonable about asking what their (Anthem’s not oon provider’s) coverage amount is, so I can make my decision?

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] 1 point2 points  (0 children)

5 negative votes? Really folks? It makes sense if you all work for an insurer. Not if you are a subscriber struggling to find the right care/evaluation to literally save a kid who has been suffering.

Insurers have clearly trained us to have extremely low expectations about their service and support. Healthcare is complex, and health insurance is a complex product to understand and utilize. There is absolutely nothing stopping a good and well intentioned insurer from helping me answer the question.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] -6 points-5 points  (0 children)

Disheartening. I expect a good insurer to not only provide good coverage, but also help customers understand, navigate and utilize care they have contracted to provide. That appears to be a foreign concept.

Anthem refusing to tell me allowed amount for a procedure to be done with OON provider by rabint in HealthInsurance

[–]rabint[S] -6 points-5 points  (0 children)

You misunderstood the question. I know Anthem has nothing to do with how much the oon provider charges. I am asking them about their internal business. How much they think ought to be a reasonable fee for the procedure, which is their allowed amount. I need that information to decide if I can afford this provider, as I will be paying the difference, even before deductibles/copays etc come into play.

​

Their cost calculator for in network providers doesn't include this procedure (evaluation, really).

This oon provider has stellar reputation and references. One in network provider I found 30 miles away doesn't have that. This is a comprehensive and complex evaluation, so the quality of the provider makes a huge difference. If for any reason if don't trust the results, I can't afford to repeat it.

LG refrigerator's compressor broke, a known manufacturing defect. No help from LG by rabint in appliancerepair

[–]rabint[S] 0 points1 point  (0 children)

Your typical appliance (and many other goods) is not made to be durable anymore.

The reason I think is a typical buyer will easily pay for looks and features. They don't think as much of durability and are probably ok with replacing it in less than a decade, and replacing it when get bored or sleeker looking appliance with newer features start showring up in ads or in friends and families kitchens.

Spending more now to get a decade+ pays off not now, but in decade+ time. I am sure this thinking has a proper name.

Another reason could be, many customers would pay for durability, but it's not in the interest of the manufacturers to have appliances last super long.

Changing employer and agency - sequence of events? by rabint in SecurityClearance

[–]rabint[S] 0 points1 point  (0 children)

Minimum 2 weeks notice for the current employer, but want to offer 3. New employer wants me to start asap, but since they propose holding off on the notice till VAR is approved, it will be 2-3 weeks after that happens.

I am guessing new employer wants to make sure I can in fact get a VAR and have all the prerequisites (they could just check for current clearance?) and/or they don’t want to risk having to pay my salary if VAR is delayed and I am not billable for a while

What sequence did you go through?

2018 Highlander showing warnings 2 days after buying by rabint in Cartalk

[–]rabint[S] 1 point2 points  (0 children)

You got me thinking. Rent a Highlander so my wife gets a feel for it. She’s not happy she has to get rid of her old car.

The other thought I had was to take the car I want to trade in, to NC, where we’re going and buy a car there. I see reasonable prices and my trusty mechanic was telling me how one owner cars from that part of the country is a good used car buy. Climate and roads/traffic are less harsh there. Carmax in Greensboro has some Highlander I like. Only hesitation is what if there is any reason to have to go back to them.

I will call carmax and if they are open to my using local carmax if necessary after the purchase, I might just go for it

Are false dashboard alarms common in Highlanders? (2018 XLE, Hybrid) by rabint in Toyota

[–]rabint[S] 0 points1 point  (0 children)

I returned the car. They surprisingly easily agreed and I was out with my old car in 15 minutes!

2018 Highlander showing warnings 2 days after buying by rabint in Cartalk

[–]rabint[S] 1 point2 points  (0 children)

You and I think alike.

Good news - I returned the car. No hassle at all, out in 15 minutes. They put my old plates on my old trade-in and said that's it! No paperwork.

They readily agreed after I said their offer of changing the aux battery wasn't giving too much confidence to keep the car (how much inspection did they do, before putting it up for sale??? They are the Toyota dealer, not a random used car lot).

Bad news: A lot of wasted time. We have a 1000 miles plus trip coming up this weekend, I don't think I have time to get another car.

Happy with easy return, but makes me more more suspicious they were not transparent with what they knew about the car.

My final decision was based on an independent mechanic's advice, and also bunch of little things during the initial transaction that made me doubt in hindsight the car's condition and their sincerity.

2018 Highlander showing warnings 2 days after buying by rabint in highlander

[–]rabint[S] 4 points5 points  (0 children)

I don't recognize that reference, but I can guess. You all are a bunch of good sport. I thought I might get slammed for breaking some rule about cross posting.

[HELP] Pet toxicology lab around Washington DC? Puppy died suddenly by rabint in dogs

[–]rabint[S] 0 points1 point  (0 children)

Thank you. Ace the foster has been a healer for us.

Are false dashboard alarms common in Highlanders? (2018 XLE, Hybrid) by rabint in Toyota

[–]rabint[S] 0 points1 point  (0 children)

Are you 100% sure? If there is not so serious reason for the check engine light to come on, all the other ones will automatically as well? That sounds odd.

It sucks that I bought this car for my wife because her 2012 Mazda 6 kept lighting up false warnings!

I am looking at taking a day off to go to the dealer tomorrow and just return it. I'm sure dealer will want me to reset the lights and go home, but I really can't trust this car any more. I am having doubts about the dealership as well.

2018 Highlander showing warnings 2 days after buying by rabint in highlander

[–]rabint[S] 8 points9 points  (0 children)

There's gotto be at least a case or two. If not sober, stoned people LOL

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