s*****t
发帖数: 3899 | 1 3年前没问题，保险cover的。这次居然说out of provider network,
大家自己掏腰包吗？可以去砍价吗？谢谢 | l******0
发帖数: 2248 | 2 我也在加州，11年生老大也是拒付，我当时是自己给了，这次也一样。听说以前都是付
的。 | k****i
发帖数: 1126 | 3 我去年生娃的时候也收到账单了，同样的原因。
我跟保险公司电话解释这个是必须的screening，后来保险公司就file claim，帮我交
了。
也是162刀的账单，我的保险是blue cross，不过我觉得每个公司都差不多。
【在 s*****t 的大作中提到】
: 3年前没问题，保险cover的。这次居然说out of provider network,
: 大家自己掏腰包吗？可以去砍价吗？谢谢
| j****l
发帖数: 416 | 4 几周前刚付了，没有任何问题啊，aetna hmo
★ 发自iPhone App: ChineseWeb 7.8
【在 s*****t 的大作中提到】
: 3年前没问题，保险cover的。这次居然说out of provider network,
: 大家自己掏腰包吗？可以去砍价吗？谢谢
| S*****a
发帖数: 142 | 5 我的保险开始也没cover,也说不在network里，后来我file 了appeal,然后保险公司就
服软pay了，没走appeal直接pay了。模板如下，也是综合了以前一个mm发在huaren上的
,希望有用。
To whom it may concern,
This appeal is with regard to the claim ### (service date: XX/XX/XXXX,
amount: $$$) under the member ID XXX (Name: XXX; DOB:XX/XX/XXXX). The claim
is about California prenatal screening on first trimester blood test.
The insurance did not pay the claim because the provider was considered as
‘out of network’, and therefore the charged amount was applied to the
deductible. However, according to California Department of Public Health, no
payment of claims based on a determination that the CA Prenatal Screening
Program is an 'out of network' provider is not consistent with California
law and regulation".
In particular,
1. The screening was referred by a in the network physician (XXX, OB/GYN, ob
's address) and done by a in-network laboratory (Quest？）. The result was
sent to Genetic Disease Branch for analysis, which is the only provider in
CA that provides this service. The patient had no choice for another
provider.
2. The patient is a California resident. The CA is legislatively authorized
to promote as statewide program of testing for prenatal screening services
to all pregnant women. By CA law and regulation, prenatal screening with
maternal blood markers can only be performed by the CA prenatal Screening
Program. Therefore, non-payment of claims based on a determination that the
CA Prenatal Screening Program is an "out of network" provider or "non PPO
provider" is not consistent with CA law and regulation.
Therefore XXX (insurance name) should reverse the decision. Please find
attached the copy of the bill from Prenatal Screening Program, California
Department of Public Health. Thank you for reconsidering this claim.
Best wishes,
XXX
【在 s*****t 的大作中提到】
: 3年前没问题，保险cover的。这次居然说out of provider network,
: 大家自己掏腰包吗？可以去砍价吗？谢谢
| s**u
发帖数: 2294 | 6 我12年上半年做的还是cover啊
【在 l******0 的大作中提到】
: 我也在加州，11年生老大也是拒付，我当时是自己给了，这次也一样。听说以前都是付
: 的。
| s**u
发帖数: 2294 | 7 不过也是先收到账单让我付，我就问了一下ob，ob说应该是保险cover的，我就给保险
打电话，他们就让我别管了
【在 s**u 的大作中提到】
: 我12年上半年做的还是cover啊
| s**********v
发帖数: 1379 | 8 就是要打电话argue
【在 s*****t 的大作中提到】
: 3年前没问题，保险cover的。这次居然说out of provider network,
: 大家自己掏腰包吗？可以去砍价吗？谢谢
|
| s*****t
发帖数: 3899 | 9 Thanks a lot, going to try.
claim
no
【在 S*****a 的大作中提到】
: 我的保险开始也没cover,也说不在network里，后来我file 了appeal,然后保险公司就
: 服软pay了，没走appeal直接pay了。模板如下，也是综合了以前一个mm发在huaren上的
: ,希望有用。
: To whom it may concern,
: This appeal is with regard to the claim ### (service date: XX/XX/XXXX,
: amount: $$$) under the member ID XXX (Name: XXX; DOB:XX/XX/XXXX). The claim
: is about California prenatal screening on first trimester blood test.
: The insurance did not pay the claim because the provider was considered as
: ‘out of network’, and therefore the charged amount was applied to the
: deductible. However, according to California Department of Public Health, no
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