Anthem blue cross HMO ?

[dreamin_disney]

Hello. Does anyone work for or have Blue cross HMO for chiropratic?
I'm paying out of pocket for chiroprator but was told if my Dr. gives me a letter or RX the insirance might cover it. I know When i tried getting accupunture the Dr. was all for it but insurance denied it.
I tried getting accu for severe
-constipation (even had a colonoscopy done)
-highblood pressure
-pre diabetis was having really sore feet and bad circulation
-headaches
-hormone imbalance
-inflamation in my body
-high liver enzymes so i cant take any over the counter pain meds... for bad headaches

I was denied but if i was pregnant then i would have been covered for nausua and headaches Accu Dr. told me insurance rarely cover acc even if plan covers it.


Sooooo I ended up with plantar faciitis and my Flex acct said they will cover reflexology if Dr. wrote an RX for it and reason why its needed. My Dr. did so hope it works. Well My sis recommend a good reflexology place and its also a chiropractor place. I'm having lots of issues with my right side like my muscles are tight and i'm outta of alignment. It started with my right stomach area when i'd get really constipated then straight through to the back very tight. like it wants to pop but cant. then it moved to my below and around my shoulder blade. Then to the side of my breast under my underarm and its swollen. Then a month ago I started with issues with plantar faciitis and tight right calf. Its all on my right side....

so I went for the reflexology and for$50 more I could get a consaultation and adjustment. I was planning on using my flex account but was told my insurance my cover the chiro and that would save me a lot of money cause co pay would be $10-15 instead of $45 then I only need to pay for reflexology which would be covered with flex acct.


How strict is blue cross? I'm just worried it will be denied. Therapist said my hips seemed tight and seems like siatic nerve issues. Plus i have plantar faciitis and she said its all connected neck(rigfht side is stiff notted), mid back and the foot. My lover back/butt feels a lil burning or tingling.

so i'm not sure how to talk to my Dr. about the rx or what to put on it so its not denied. I asked chiro and she said if its just for the foot it will only maybe be 4 visits but for lower back insurance cover more visits. I just have different issues going on so not sure how to put it on rx since its all the right side.


any advice how to go about it. My last chiro (of 3 years)I paid out of pocket because he only took cash or check and he was recommend but my last 2 visits my foot felt worse and I was more stiff and more pain but i'm loving this new chiro and leave feeling better and she takes creditcard-lol!

 

[Tink-aholic]

Since insurance plans are like snowflakes and you and I could both have the same insurance but they could cover completely different things, I would suggest you call Blue Cross. Write down the confirmation number they give you during the call.

Keep in mind that reflexology is, by definition, an alternative medicine. It isn't likely that it will be covered by a traditional insurance plan, particularly if you haven't exhausted all medical approaches first. Have you visited a podiatrist for your plantar fasciitis?

 

[Princesca]

Having worked at Humana in the past, in plan benefits, I can tell you that it's extremely complicated. Even if your documentation says you're covered, half the time it's probably not loaded right in the system, especially for something like chiropractic care.

Chiro is usually covered at a certain number of visits per year, if it's covered at all. Sometimes those are just for chiro, but other times they share with other physical, speech, hearing therapy services. If you don't use the right system calculation to load the plan, that gets all messed up. Probably half the incorrectly paid claims I ever saw were for something related to physical therapy or chiro.

If your SPD (summary plan document) from your employer says that it's covered, but you get rejected, keep pushing back. If this happens, and you want to send me a PM, I'll see if I can help you ask the right questions to get it resolved.

 

[Princesca]

I would also add that your doctor needs to make sure to use the right diagnosis code, to make it clear that this is an actual medical illness. Your doctor should know how to code things to make sure it's billed under the correct cause/diagnosis codes, etc.

 

[dreamin_disney]

Since insurance plans are like snowflakes and you and I could both have the same insurance but they could cover completely different things, I would suggest you call Blue Cross. Write down the confirmation number they give you during the call.

Keep in mind that reflexology is, by definition, an alternative medicine. It isn't likely that it will be covered by a traditional insurance plan, particularly if you haven't exhausted all medical approaches first. Have you visited a podiatrist for your plantar fasciitis?

Reflexology will be paid out of pocket. Then I'll get it reinbursed through my Medical flex acct as long as i send in the rx from my Dr.

I went to my primary Dr. and she basically said what it was, gave me a sheet with info and exercises. She also told me to get dr. shols inserts. She told me she even had it so bad she had to have a shot. She was behind in her rounds so it was rushed. I was there for an hour. She told me to come back in 4 weeks so hopefully I have more time with her to discuss everything.

Having worked at Humana in the past, in plan benefits, I can tell you that it's extremely complicated. Even if your documentation says you're covered, half the time it's probably not loaded right in the system, especially for something like chiropractic care.

Chiro is usually covered at a certain number of visits per year, if it's covered at all. Sometimes those are just for chiro, but other times they share with other physical, speech, hearing therapy services. If you don't use the right system calculation to load the plan, that gets all messed up. Probably half the incorrectly paid claims I ever saw were for something related to physical therapy or chiro.

If your SPD (summary plan document) from your employer says that it's covered, but you get rejected, keep pushing back. If this happens, and you want to send me a PM, I'll see if I can help you ask the right questions to get it resolved.

ok Thank you

I would also add that your doctor needs to make sure to use the right diagnosis code, to make it clear that this is an actual medical illness. Your doctor should know how to code things to make sure it's billed under the correct cause/diagnosis codes, etc.

My Dr. and the Chiro Dr. are two different places with no connection to each other. The girl told me just to have My primary Dr. write on a RX chiro needed for__________ then she(chiro front clerk) would send that in to the insurance and thats all that was needed Then once its approved they enter the codes for the billing.

if its covered your right its so many visits per year. If they dont cover then I will pay out of pocket then send it into flex acct.

I've gone twice and feel better, I'll money in my flex acct for a few more visits. I'm just glad that she takes creditcard so when my flex acct runs out I can still go. Plus my budget self is using my citi cash rewards so I'm earning money. every lil bit helps-lol! But hopefully I feel 100% soon

 

[Princesca]

I hope so too. Have you looked into orthotics? A friend of mine has them, I'm pretty sure for plantar fascitis or however you spell it... and she swears by them.

 

[disney_me]

You know you can be seen by a Physical Therapist for both problems. More insurances cover a PT visit then the chiro or a reflex . You may need a script from your PCP. I would check with your insurance company to also make sure you don't need a referral or an authorization.

Good luck!