Confusing question about health insurance...help if you can

[ryanshana]

Ok my son have a speech delay. Therefore, he is in the intermediate unit and was in Early Intervention since 18 mo. Because of that, he is considered to have a disability he gets insurance through the EI/IU. It is called Keystone Mercy. Not alot of places take this insurance. It is NOT our primary insurance. Our primary is through my DH work and it is Cigna.

Ok here is my issue. We just moved. My son is sick so I went to take him to a family practice (we moved back to my hometown and this is my old family practise). I give them his cigna card and ask them if they also take Keystone mercy (KM) They said no they do not. I said ok. The only reason why I ask them this is because our Cigna has a $10 co-pay, if they take KM then I do not have to pay the co pay because KM is 0 deductible for everything. Since we have Cigna it has to go thru them first and then KM picks up the rest.

They then proceed to tell me that they cannot see him because they do not take KM. I have NEVER had this issue before (his previous pedatrition also does not take KM, and he has had KM since he was 18 mo). I explained to them that everyone else that has seen him if they do not take KM then it's just like the card doesn't exsist. I pay the $10 copay and he gets seen. They were saying that doing that is illegal. I have NEVER heard of this. We RARELY use the KM card (because no one really takes it besides his outpatient speech therapy) I'd rather not have the KM card if that is the case. They were saying something about it's illegal to do that because if Cigna doesn't cover something....like a procedure that it's illegal not to charge the KM and since they don't take the KM that is why he can't be seen. Which also doesn't make sense because I would just pay OOP for that then. There were 3 nurses debating this...1 was agreeing w/ me....the other 2 explained the above to me. Has anyone heard this before?

I hope this makes sense and I hope that someone can clear this up for me. Thanks!

 

[agnes!]

You're right, you do have a confusing question, I'm confused by the whole thing. I think you probably should check with your insurance carriers or your DH's company's insurance specialist or the CS at Cigna or maybe the Customer Service group at Keystone. Don't rely on the nurses' hearsay, they might not be up on all the various rules...
Whatever the rules actually state, get it all in writing so you won't possibly have this issue in the future with other providers.

agnes!

 

[Daisybelle]

I have a feeling the person you spoke with is confused. As long as they are a contracted Cigna provider and that is your primary insurance, they should be able to see your son. I work at a large medical facility in the insurance resgistration department, and unfortunately sometimes new staff who work up front will misunderstand something and turn a patient away. Cigna should be able to tell you if that facility is within their provider network.

 

[npmommie]

Ok my son have a speech delay. Therefore, he is in the intermediate unit and was in Early Intervention since 18 mo. Because of that, he is considered to have a disability he gets insurance through the EI/IU. It is called Keystone Mercy. Not alot of places take this insurance. It is NOT our primary insurance. Our primary is through my DH work and it is Cigna.

Ok here is my issue. We just moved. My son is sick so I went to take him to a family practice (we moved back to my hometown and this is my old family practise). I give them his cigna card and ask them if they also take Keystone mercy (KM) They said no they do not. I said ok. The only reason why I ask them this is because our Cigna has a $10 co-pay, if they take KM then I do not have to pay the co pay because KM is 0 deductible for everything. Since we have Cigna it has to go thru them first and then KM picks up the rest.

They then proceed to tell me that they cannot see him because they do not take KM. I have NEVER had this issue before (his previous pedatrition also does not take KM, and he has had KM since he was 18 mo). I explained to them that everyone else that has seen him if they do not take KM then it's just like the card doesn't exsist. I pay the $10 copay and he gets seen. They were saying that doing that is illegal. I have NEVER heard of this. We RARELY use the KM card (because no one really takes it besides his outpatient speech therapy) I'd rather not have the KM card if that is the case. They were saying something about it's illegal to do that because if Cigna doesn't cover something....like a procedure that it's illegal not to charge the KM and since they don't take the KM that is why he can't be seen. Which also doesn't make sense because I would just pay OOP for that then. There were 3 nurses debating this...1 was agreeing w/ me....the other 2 explained the above to me. Has anyone heard this before?

I hope this makes sense and I hope that someone can clear this up for me. Thanks!

I would call Cigna and ask. If Cigna is his primary insurance and the practice accepts that insurance there should be no problem.
the KM would kick in for things not covered by cigna.

but since they don't take KM than you would be responsible if that practice ordered a test or procedure not covered by cigna.
does that make sense? it is confusing but call Cigna
if that is primary insurance and they accept it, there shouldn't be a problem

 

[Disney Doll]

I would call Cigna and ask. If Cigna is his primary insurance and the practice accepts that insurance there should be no problem.
the KM would kick in for things not covered by cigna.

but since they don't take KM than you would be responsible if that practice ordered a test or procedure not covered by cigna.
does that make sense? it is confusing but call Cigna
if that is primary insurance and they accept it, there shouldn't be a problem

What she said.

 

[ryanshana]

I would call Cigna and ask. If Cigna is his primary insurance and the practice accepts that insurance there should be no problem.
the KM would kick in for things not covered by cigna.

but since they don't take KM than you would be responsible if that practice ordered a test or procedure not covered by cigna.
does that make sense? it is confusing but call Cigna
if that is primary insurance and they accept it, there shouldn't be a problem

Correct...and that is what I told them and they still turned him away....

After I wrote this I actually did call....

And I was correct, the office was incorrect...just ticked me off...thanks everyone

 

[npmommie]

Correct...and that is what I told them and they still turned him away....

After I wrote this I actually did call....

And I was correct, the office was incorrect...just ticked me off...thanks everyone

glad you got it worked out